Hypertension is one of the most, important and interesting problems, encountered in Geriatric Medicine. As more than 1/3rd of elderly are hypertensives, hypertension constitutes the important risk factor, for increased morbidity and mortality. Hypertension is not a simple physiological accompaniment of ageing. This is clearly shown by the population study in the non-western societies where BP tends to be normal or even low in the aged population. When these people migrate to western society, hypertension tends to develop in their community. So the development of hypertension depends more on environmental factors and lifestyle rather than simple ageing.
Hypertension is usually defined as a systolic BP of more than 140 mm.of Hg.or a diastolic BP of more than 90mm. of Hg. regardless of age. BP above these levels needs treatment. It is not a disease with signs and symptoms and most of the hypertensives are detected by the routine recording of BP. The problem lies in the fact ,that hypertension is the major factor leading to vascular diseases, affecting the heart, brain, kidney and peripheral vessels.
Also read: Do’s and Don’ts for Senior Citizens
Risk Factors:
There are several risk factor for developing high blood pressure. These include family history, smoking, overweight, alcoholism and high sodium (common salt) intake along with low potassium and calcium intake. Hypertension is also frequent in people with tense personality and during periods of tension. Blood pressure is also known to go up in all people during periods of stress or increased physical activity.
There are some basic requirements in diagnosing and investigating hypertension in elderly. Since the BP readings are variable, multiple recording at various timings should be done always. This will avoid the error of diagnosing hypertension. Conditions like fever, full bladder, pain etc. can cause a transitory rise of BP.
Once hypertension is established investigations to assess the end-organ damage are to be done like:
Urine analysis, blood urea, serum creatinine, serum electrolytes, blood sugar, lipid profile, ECG, chest X-ray.
These are the major consequences of hypertension if it is not treated:
- Heart – Heart attack, heart failure
- Brain – Stroke, dementia
- Blood Vessels – Reduced blood circulation to limbs
- Kidney – Kidney failure
- Eyesight – Failure of vision
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Treatment:
The good news about hypertension is that it can be reduced by drugs and often by changes in lifestyle. The ideal method of treatment depends on the type and severity of a disease as well as other co-existing medical problems.
In mild to moderate hypertension non drug therapy may be tried.
Eg. * Reduce excess weight * Stop smoking
* Restrict salt intake * Regular physical exercise
* Meditation * Avoid stress
All hypertension patients should continue treatment after BP is controlled, because BP is likely to increase if treatment is discontinued. Stepping down therapy (reducing the drug to the optimum dosage) can be tried slowly. If BP increases, therapy must be stepped up again.
Blood pressure medicines:
There are different types of medicines your doctor may prescribe for you. Do not be disheartened or discouraged if you are advised long term drug therapy. Sometimes you can take smaller doses after your blood pressure is under control, but you may always need some treatment.
There are several types of blood pressure medicines. The common ones are those which eliminate excess salt and water from the body (diuretics) and those which relax and open up the narrowed blood vessels (beta blockers, ACE inhibitors, calcium channel blockers).
Like all medicines, blood pressure medicines have several side effects. These include, weakness, tiredness or leg cramps, impotence, cold hands and feet, depression, disturbed sleep, slow or fast heartbeat, skin rash, loss of taste, dry cough, ankle swelling, headache or dizziness and constipation. You should be aware of these symptoms and consult your doctor if they bother you too much.
• Hypertension is not a disease, but it is a definite risk factor.
• In general, hypertension is not a diagnostic emergency.
• Before initiating the therapy, multiple readings are essential.
• They non-drug therapy in mild to moderate cases.
• In choosing the anti-hypertensives consider the concomitant diseases.
Excerpts from the book ‘ Good Bye to Old Age’ authored by Dr. V. S. Natarajan
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