The influence of age on blood pressure evaluation of hypertensive subjects (original) (raw)
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Age-related changes in blood pressure
Hypertension, 1986
This report is based on three different representative population samples of a total of 1304 men (50-79 years old) and 1246 women (38-79 years old) observed for up to 12 years. Subjects' consumption of antihypertensive drugs and blood pressure levels in subjects with and without such treatment are presented. The prevalence of treatment with antihypertensive drugs (including beta-blockers and diuretics for other indications) increased from 2% at age 50 years to 37% at 79 years of age among the men and from 1% at 38 years to 61% at 79 years of age among the women. The mean systolic/diastolic blood pressure in untreated subjects increased from 138/91 mm Hg at age 50 years to 159/91 mm Hg at age 70 years in the men and from 123/79 mm Hg at age 38 years to 168/93 mm Hg at age 70 years in the women. At age 79 years the mean systolic/diastolic blood pressure was 155/83 mm Hg in the men and 161/85 mm Hg in the women. In a longitudinal follow-up of reexamined subjects, there was an incre...
Blood pressure lowering in the oldest old
Journal of Hypertension, 2010
Persons aged 80 or older (the 'oldest old') represent the fastest growing age group in developed countries. Because systolic blood pressure (SBP) increases with age, hypertension is common in the oldest old. This condition was evident in 57% of 1160 older men, mean age 80 years, and in 60% of 2464 older women, mean age 81 years, in a long-term care facility [1], with two-thirds of these older persons having isolated systolic hypertension [2]. Hypertension prevalence was as high as 67.2% among 1002 Chinese patients aged 80 or more in retirement centers for army officers [3], and reached 74% in patients 80 years or older in the Framingham study . High BP values cause a striking increase in the risk of target organ damage and cardiovascular mortality and morbidity, particularly stroke and coronary heart disease, as well as of chronic kidney disease. Despite this, many very elderly patients continue to live with uncontrolled or inadequately controlled hypertension. In the aforementioned study based on Framingham data, for example, only 38% of men and 23% of women aged 80 or more had BP values controlled to 'target' [defined as SBP <140 and diastolic BP (DBP) <90 mmHg] [4].
ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly
Circulation, 2011
Recommendations for Management General Considerations Because there is limited information for evidence-based guidelines to manage older hypertension patients, the following recommendations are based on expert opinion that we believe provide a reasonable clinical approach. Evaluation of the elderly patient with known or suspected hypertension must accurately determine BP, and if elevated: 1) identify reversible and/or treatable causes; 2) evaluate for organ damage; 3) assess for other CVD risk factors/comorbid conditions affecting prognosis; and 4) identify barriers to treatment adherence. Evaluation includes a history, physical exam, and laboratory testing. It is most important to focus on aspects that relate to hypertension, including details concerning the duration, severity, causes, or exacerbations of high BP, current and previous treatments including adverse effects, assessment of target organ damage, and other CVD risk factors and comorbidities, as noted in the preceding text. There is limited evidence to support routine laboratory testing. Instead, a more deliberative, reasoned approach to testing is recommended: 1) urinalysis for evidence of renal damage, especially albuminuria/microalbuminuria; 2) blood chemistries (especially potassium and creatinine with eGFR); 3) total cholesterol, low-density lipoprotein cholesterol, highdensity lipoprotein cholesterol, and triglycerides; 4) fasting blood sugar (including hemoglobin A1c if there are concerns about diabetes mellitus); and 5) electrocardiogram (ECG). In selected elderly persons, 2-dimensional echocardiography is useful to evaluate for LVH and LV dysfunction that would warrant additional therapy (ie, angiotensin-converting enzyme inhibitors [ACEIs], beta blockers). BP Measurement and Goals Reliable, calibrated BP measurement equipment is essential for hypertension management. The BP should also be measured with the patient standing for 1 to 3 minutes to evaluate for postural hypotension or hypertension. The general recommended BP goal in uncomplicated hypertension is Ͻ140/90 mm Hg. However, this target for elderly hypertensive patients is based on expert opinion rather than on data from randomized controlled trials (RCTs). It is unclear whether target SBP should be the same in patients 65 to 79 years of age as in patients Ͼ80 years of age. QoL and Cognitive Function Because symptomatic well-being, cognitive function, physical activity, and sexual function are diminished by aging and disease, it is important to give particular attention to QoL areas when making therapeutic decisions. Nonpharmacological Treatment Lifestyle modification may be the only treatment necessary for milder forms of hypertension in the elderly. Smoking cessation, reduction in excess body weight and mental stress, modification of excessive sodium and alcohol intake, and increased physical activity may also reduce antihypertensive drug doses. Weight reduction lowers BP in overweight individuals, and combined with sodium restriction, results in greater benefit. BP declines from dietary sodium restriction are generally larger in older than in young adults. Increased potassium intake, either by fruits and vegetables or pills, also reduces BP, especially in individuals with higher dietary sodium intake. Alcohol consumption of Ͼ2 alcoholic drinks per day is strongly associated with BP elevations, and BP generally declines after reduced alcohol intake, though evidence is limited among older adults. Exercise at moderate intensity elicits BP reductions similar to those of more intensive regimens. Management of Associated Risk Factors and Team Approach Many risk stratification tools calculate risk estimates using an overall or "global" instrument like the Framingham Risk Score for predicting MI, stroke, or CVD. These instruments emphasize age and classify all persons Ͼ70 or 75 years of age as high risk (ie, Ն10% risk of CAD in next 10 years), or very high risk (eg, those with diabetes mellitus or CAD), thus deserving antihypertensive therapy. Furthermore, analyses have not suggested that elderly subgroups differed from younger subgroups in response to multiple risk interventions. Patient management is often best accomplished by employing a health care team that may include clinical pharmacists, nurses, physician assistants, clinical psychologists, and others (as necessary). Technology enhancements to assist in achieving and maintaining goals range from simple printed prompts and reminders to telemedicine and text messaging.
Cardiovascular clinics, 1981
ABSTRACT. A review on the effects of ageing on cardiovascular function, with special reference to high blood pressure (BP), is given in this seminar. In most western populations the diastolic and especially the systolic BP increases with age in both sexes and this has been ...
The Hypertension in the Very Elderly Trial - latest data
British Journal of Clinical Pharmacology, 2013
Early trials in the field of hypertension focused on adults in their fifties and sixties. However, with the passage of time, a progressive effort has been made to expand the evidence base for treatment in older adults. 2008 saw publication of data from the Hypertension in the Very Elderly Trial which demonstrated significant mortality and morbidity benefits from antihypertensive therapy in octogenarians. More recently, additional data from this cohort has been published suggesting that appropriate anti-hypertensive therapy may lead to a reduction in incident cognitive impairment and fractures, whilst a 1 year open label extension of the main study confirmed many of the original trial findings. This review provides an overview of the Hypertension in the Very Elderly Trial whilst also discursively evaluating the latest data.
Blood pressure and hypertension in an elderly population
European Journal of Epidemiology, 1990
In order to study the epidemiology of hypertension in the elderly and its relationship to other disease situations, a study was performed on 815 institutionalized elderly people indicating a statistically significant decrease of both systolic and diastolic blood pressure with age.
2015
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