Complications Of Hypertension In The Elderly
Untreated high blood pressure in older people causes some potentially life-threatening complications. While most of these problems wont present themselves until old age, there arent complications of hypertension only in elderly people. In fact, more and more young people have hypertension, so diagnosing and treating it on time is crucial for preventing the following problems:
Q: What Level Of Improvement In Blood
A: It can make a big difference. Every kilogram you lose about 2 to 2½ pounds has been shown in studies to lower your systolic blood pressure a point. We recommend the DASH diet, which is low salt, low cholesterol, low fat, high in vegetables. That can lower your blood pressure five to 10 points. Certainly things like stopping smoking can have major effects on your blood pressure and your risk.
More Than Blood Pressure
The new guidelines have other changes, too. First, they don’t offer different recommendations for people younger or older than age 65. “This is because the SPRINT study looked at all patients regardless of age and didn’t break down groups above or below a certain age,” says Dr. Conlin.
The guidelines also redefined the various categories of hypertension. It eliminated the category of prehypertension, which had been defined as systolic blood pressure of 120 to 139 mm Hg or diastolic pressure of 80 to 89 mm Hg. Instead, people with those readings are now categorized as having either elevated pressure or Stage 1 hypertension .
A reading of 140/90 mm Hg or higher is considered Stage 2 hypertension, and anything higher than 180/120 mm Hg is hypertensive crisis.
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The New Normal Isnt Really Normal
Lets start with a quick review of the revised blood pressure guidelines adopted by the American Heart Association and the American College of Cardiology in 2017:
- Normal: 120 over 80
- Elevated: 120-129 systolic, 79 or less diastolic
- Stage one hypertension: 130-139 systolic, 80-89 diastolic
- Stage two hypertension: 140 or higher systolic, 90 or higher diastolic
These guidelines are ideal not for keeping people in prime health, but for selling a massive amount of BP drugs. And theyre a long way from the previous, more lax standard where hypertension didnt begin until your BP reached 140 over 90.
AHA and ACC officials are clearly erring on the side of caution, but for healthy people with no other cardiovascular problems, regarding 120/80 as normal is just plain wrong. Thats a pretty aggressive target, particularly for older adults.
And it exacerbates the problem when doctors add prescription drugs to the equation in an effort to drastically lower your BP numbers.
For seniors, this is more than a problem its an outright hazard
What Are The Best Ways To Lower Blood Pressure
Physical activity is no doubt one of the fastest, most natural ways to lower your blood pressure. Walking for even just half an hour each day can bring your blood pressure down. Of course, the more exercise you do, such as riding a bike, the greater the results you’ll see.
You should also feast on more berries, bananas, beets, kiwis, and watermelon. Dark chocolate, oats, and leafy green veggies are also BP-friendly food choices.
As for healthy beverages, try reaching out for unsalted tomato juice. Researchers found that one cup a day can improve both SBP and DBP. The scientists also say it can help reduce bad cholesterol levels.
Juice made from beets, prunes, and berries, as well as tea and skim milk, may also benefit your blood pressure. You should also try oat milk, a healthy, delicious alternative to dairy milk.
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Older Adults And Hypertension: Beyond The 2017 Guideline For Prevention Detection Evaluation And Management Of High Blood Pressure In Adults
Epidemiology of Hypertension in Older Adults
Hypertension is one of the primary modifiable risk factors for cardiovascular disease and its prevalence and severity both increase with age. According to the US National Health and Nutrition Examination Survey , 70% of adults 65 years have hypertension.1 This number will continue to rise as our population ages as 15% of the US population was 65 years old in 2014 and this is expected to increase to 20% by 2050.2
Despite having the highest prevalence of hypertension and greatest risk for CV morbidity and mortality, older adults are frequently undertreated for elevated blood pressure . This group has been traditionally excluded or underrepresented in clinical trials due to concerns regarding frailty, fall risk, poor renal function, abnormal hemodynamic adaptation, and higher risk for autonomic dysfunction, cognitive impairment, and polypharmacy. With advancing age, the gap between chronological and biological age widens and chronological age may be a poor surrogate for biological age.3 Furthermore, chronological age cutoffs used to identify older patients across guidelines are inconsistent and BP treatment targets remain controversial.
Hypertension Guidelines Reviewed
Table 1: A Comparison of Blood Pressure Thresholds and Targets between ACC/AHA, ACP/AAFP, and ESC/ESH Guidelines
|SBP 130-139 mmHgDBP 70-79mmHg|
Hypertension Management in Older Adults with History of Coronary Artery Disease
Figure 1:Figure 1:
Be Proactive About High Blood Pressure Management
Regardless of which guidelines you find most persuasive, what is most important is for you to be proactive in making sure that your high blood pressure management is correctly tailored to you. This means:
- Making sure your blood pressure is correctly and reliably assessed. Ask questions if you are diagnosed or have your medication adjusted based on quick occasional office-based checks. Home blood pressure readings can be a huge help in getting BP reliably assessed.
- Talking to your doctors about what your BP treatment goal should be, and why. Goals are best determined through a conversation between health professionals and patients. Your doctor should be able to discuss with you the pros and cons of aiming for a moderate goal versus a more intensive goal. Obviously, you will be able to ask better questions if youre informed about the key studies on high blood pressure in older adults I describe them in my article about SPRINT-Senior.
- Getting help implementing lifestyle modifications that help lower blood pressure. Many non-drug approaches have been proven to help lower blood pressure, and they can often benefit your health in other ways.
I also recommend asking extra questions about blood pressure if youve had any concern about falls or near-falls. Although SPRINT did not find that intensive blood pressure treatment resulted in increased falls, both groups did experience some falls and other research has linked blood pressure treatment to falls.
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What The New Blood Pressure Guidelines Mean For Caregivers
AgingCare.com only publishes articles that wont be published elsewhere on the web, so I cant post the whole thing here. But here are the highlights related to the December 2013 BP guidelines:
- A higher target BP for adults aged 60 or older. The recommended goal BP is now less than 150/90, instead of less than 140/90 .
- A higher target BP for people with diabetes and/or kidney disease. The recommended goal BP is now less than 140/90, instead of less than 130/80.
What does this mean for you, if youre caring for aging parents or other older persons? It means you should check on how their BP has been doing.
If its been much lower than the numbers above, you should consider discussing the BP medications with your parents doctor. This is especially important if youve had any concerns about falls or balance. For specific recommendations on how to make sure your older loved one isnt getting too much blood pressure medication, read my full article at AgingCare.com. I also offer tips on checking BP in this post: Why I Love Home Blood Pressure Monitors.
Last but not least, I provide more guidance on figuring out hypertension treatment here: 6 Steps to Better High Blood Pressure Treatment for Older Adults.
The Blood Pressure Chart In Canada: Taking And Interpreting The Numbers
The best blood pressure monitor in Canada used in healthcare offices is the AOBP monitor. AOBP stands for Automated Office Blood Pressure.
Outside of the doctor’s office, a home blood pressure monitor will suffice. In fact, health experts recommend their use for patients with insufficient BP control. Health experts refer to this as home blood pressure monitoring .
Here are some of the guidelines to keep in mind when buying and using a blood pressure monitor.
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Diastolic Vs Systolic Blood Pressure
Diastolic pressure occurs whenever the heart relaxes, and blood fills it up. Systolic pressure occurs when the heart contracts and the blood gets pushed out of the heart.
According to health experts, both types of blood pressure are equal in importance. However, higher SBPs appear to come with higher risks of cardiovascular disease.
However, diastolic blood pressures can also go up due to a high-sodium diet. It also tends to be higher in patients with obesity and high alcohol consumption. Having a sedentary lifestyle and some types of medications can also make the DBP go up.
Aside from your SBP and DBP, you should also keep track of your pulse pressure.
Your pulse pressure is the actual difference between your SBP and DBP. So if your BP reading is 120/80, your pulse pressure is 40. Health experts say that the normal pulse pressure is 40 mmHg.
How To Combat High Blood Pressure For Seniors
Always check with your doctor for their expertise to aid you in a clear path to improved health. They may recommend a medication to get your blood pressure under control. In addition to consulting your doctor, the following tips may also help your circulatory systems health.
- Eat a heart-healthy diet that includes fish with omega-vitamins, whole grains, fruits, and vegetables.
- Incorporate stress-management techniques into your daily routine. Yoga, Tai Chi, and daily stretches can moderate your stress and also help you improve balance.
- Get a good nights sleep. Not only will some shut-eye help your blood pressure, but it will also boost your brain function.
- Get up and get moving. Physical exercise can help your heart health and enhance your spirits as well.
The passionate staff at Civitas Senior Living are here for all of your health needs. Whether you need help making a doctors appointment, assistance with medication management, or guidance with exercise and nutrition, a loving caretaker is here for you. Contact us to learn more about our heart-healthy activities.
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What You Need To Know About The New Blood Pressure Standards
If youre an American adult, there is a 46 percent chance you have high blood pressure. The odds increased in November when the American Heart Association and American College of Cardiology issued new standards that lowered the threshold for the diagnosis of hypertension.
The new definition of Stage 1 high blood pressure is a systolic pressure of at least 130 or a diastolic pressure of 80 or above. Systolic refers to pressure during heart contractions, and diastolic refers to pressure between beats. The previous standard was 140/90.
The change meant 30 million more American adults have high blood pressure.
Brian Bostick, MD, PhD, is an MU Health Care cardiologist. In this Q& A, he explains the new standards and how you can keep your blood pressure in the normal range below 120/80.
Tips To Measure Your Blood Pressure Correctly
To determine whether you have hypertension, a medical professional will take a blood pressure reading. How you prepare for the test, the position of your arm, and other factors can change a blood pressure reading by 10% or more. That could be enough to hide high blood pressure, start you on a drug you don’t really need, or lead your doctor to incorrectly adjust your medications.
National and international guidelines offer specific instructions for measuring blood pressure. If a doctor, nurse, or medical assistant isn’t doing it right, don’t hesitate to ask him or her to get with the guidelines.
Here’s what you can do to ensure a correct reading:
Don’t drink a caffeinated beverage or smoke during the 30 minutes before the test.
Sit quietly for five minutes before the test begins.
During the measurement, sit in a chair with your feet on the floor and your arm supported so your elbow is at about heart level.
The inflatable part of the cuff should completely cover at least 80% of your upper arm, and the cuff should be placed on bare skin, not over a shirt.
Don’t talk during the measurement.
Have your blood pressure measured twice, with a brief break in between. If the readings are different by 5 points or more, have it done a third time.
For more on getting your blood pressure under control, buy Controlling Your Blood Pressure, a Special Health Report from Harvard Medical School.
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Question: What Are The New Blood Pressure Guidelines For Seniors
The new guidelines change nothing if youre younger than 60. But if youre 60 or older, the target has moved up: Your goal is to keep your blood pressure at 150/90 or lower. If you have kidney disease or diabetes, your target used to be 130/80 or lower now its 140/90 or lower.
What You Should Know About Fluctuating Blood Pressure In The Elderly
As you help monitor your loved ones blood pressure, keep in mind that numbers fluctuate slightly throughout the day thats normal. Several factors influence your blood pressure numbers. For example, your blood pressure may be lower if youre resting and higher if youre stressed. This means you may have a normal reading in the morning and an elevated number in the afternoon.
If youre concerned about excessive fluctuation in your loved ones blood pressure numbers:
- Read instructions to ensure youre using your home blood pressure monitor equipment correctly. Variations in how you measure your loved ones blood pressure can result in different readings.
- Bring your home monitor to your next doctors appointment to compare readings.
- Be aware of white coat hypertension. In some cases, a persons blood pressure may be high at a doctors office but normal at home. This could be attributed to the stress related to a doctors appointment.
Your loved ones doctor may want you to keep a blood pressure diary with several readings a day for a couple of weeks to monitor any variations.
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New Blood Pressure Targets And Prescribing Tips
Bruce M. is an 82-year-old patient with moderate dementia , recently admitted to long-term care following surgery for a hip fracture 6 weeks ago. Other relevant medical history includes coronary artery disease , long-standing hypertension, stage 3 chronic kidney disease , and benign prostatic hypertrophy. Medications include 10 mg of ramipril daily, 25 mg of hydrochlorothiazide daily, 50 mg of metoprolol twice daily, 10 mg of rosuvastatin daily, 81 mg of acetylsalicylic acid daily, 0.4 mg of controlled-release tamsulosin daily, 70 mg and 5600 IU of alendronatevitamin D weekly, and 1000 mg of acetaminophen 3 times daily. The bisphosphonatevitamin D pill and acetaminophen are the only new medications since his hip fracture.
The nursing staff report that Bruce appears to be light-headed and unsteady when he stands up to move with his walker. They are concerned that he will fall. Clinical data from the past week show blood pressure readings ranging from 130/84 to 118/60 mm Hg and a regular pulse of 54 to 70 beats/min. Apart from cognitive impairment and evidence of recent hip surgery, findings of his clinical examination are unremarkable, with no signs of heart failure and only a 5mm Hg postural BP drop.
As the family physician providing ongoing care to Bruce, would you consider any changes in his medical management?
How Older Adults Can Maintain A Healthy Blood Pressure
Maintaining a healthy blood pressure doesnt have to be complicated. Simple lifestyle changes can help:
- Exercise. National guidelines recommend adults of all ages engage in at least 150 minutes of moderate physical activity each week. If mobility or health conditions are a problem, older adults should try to be as physically active as possible.
- Lose weight. If your loved one is overweight, every 2 pounds lost can help reduce blood pressure by 1 mm Hg.
- Eat a heart-healthy diet low in salt. The DASH diet is rich in fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods. It was designed specifically to help lower blood pressure. Try to limit sodium to no more than 2,300 milligrams per day.
- Avoid drinking alcohol. Alcohol can raise your blood pressure. If your loved one chooses to drink alcoholic drinks, limit it to no more than one drink a day for women and up to two drinks a day for men.
- Dont smoke. Tobacco damages your artery walls. If your loved one smokes, ask their doctor how to help them quit.
- Manage stress. Try simple relaxation techniques, such as deep breathing exercises or meditation.
In some cases, diet and lifestyle changes are not enough to lower blood pressure. Your loved one may be having a difficult time achieving significant changes in their lifestyle, or their hypertension may be too severe to treat with diet and exercise alone.
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Do The Guidelines Recommend That I Do Anything Differently
Other than monitoring your blood pressure at home, they do not. The guidelines maintain the commonly held beliefs that the way to treat high blood pressure is through medication, diet, exercise, and weight loss.
Of course, since the actual definition of high blood pressure has changed, it may mean that you are now eligible for medication. Medication is usually prescribed for people who have Stage 1 hypertension and have already had a stroke. However, people who just have Stage 1 hypertension or high blood pressure can usually treat both of those things purely through lifestyle changes.