Hypertension in elderly

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2. pertension :sbp>140 dbp >90 .or patient on therapy ..circulation 2012.
Hypertension category in 7jnc in to following
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4. Old age:- officially define the old age by 60+.
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5. Who define the old age by the age of 50+ .
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6. Young old 60-69
years
Middle old 70-79
years
Oldest old more than
80+
-65to 74…
-75to 84…
-85+
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7. ≈65%of population aged 60 years are hypertensive ,only 27% are
controlled.
Ish is more prevalent in old adults.
The white coat hypertension is mistaken as ISH.
In Old adults hypertension is present in association to other
cardiovascular risk like obesity ,diabetes mellitus , dyslipidemia
,smoking and sedentary life.
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8. The accurate measurement of hypertension in old adults is challenge:
-the pseudo hypertension.
-variable reading of blood pressure …abpm.
-white coat hypertension.
n.b: Abpm and home measurement is of value if possess impact on morbidity
and mortality.
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9. high blood pressure carries high cardiovascular morbidity and
mortality.
High systolic BP and ISH are strong risk factor for cardiovascular
mortality than diastolic BP.
SBP >160 increase MR >2.4 times.
Old age are likely to get ISH and to have organ damage ,CAD ,new
cardiovascular events and less likely to get good control.
The barriers for treatment :physicians failure to realize the needs to
achieve good control.
Last barrier is the economic state of the old adult group.
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10. If high BP treated appropriately:
-reduce cardiovascular mortality
-reduce CCF.
-reduce risk of stroke
-reduce progression to CKD.
-reduced stroke related cognitive impairment and related
dementia.
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14. Prindopril against recent stroke trail : perindopril with/with out long acting
indapmide reduce the stroke related cognitive impairment by 45% and
dementia by 35%.
-an other study using nicardipine reduces the dementia by 55% in 4 years
follow up.
HYVET trial : agreed to the 7 JNV report in good control of high bp to
<140/90 and to <130/80 in DM and CKD. THE STUDY CONDUCTED OVER
1,8 YEARS ASSOCIATED TO 21% OF ALLOVER MORTALITY AND 34%
OF CARDIOVASCULAR EVENTS ,AND 30% OF STROKE.
SPRINT TRAIL: The SBP Intervention Trial will provide important
information on the risks and benefits of intensive blood pressure treatment
targets in a diverse sample of high-risk participants, INCLUIDING OLD
ADULTS ≥75 years. AND BENEFIT IN REDUCTION OF CV EVENTS BY
30%.
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20. TO INITIATE DRUG FROM LOW DOSES AND GRADUAL INCREASE
TO THE MAXIUM.
TO CONSIDER THE PRESENCE OF OTHER COMORBIDITIES:
-NO COMORBIDITY USE THIAZIDE DRUGS 7JNC.
-WITH PRIOR CAD ,OR ACUTE MI SHOULD TAKE ACE /ARBs +bb.
-old adults with CCF ACE/ARBs+BB+DURETICS.
-old adult with DM ,CKD should take ACE/ARBs are preferred.
Physician should consider drug adherence ,pseudo-hypertension ,
volume over load ,drug interaction, and presence of co-morbidity like
obesity, smoking and causes of secondary hypertension.
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