Hypertension in the elderly
Last reviewed: 23.04.2024
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Hypertension in the elderly is most often observed in the age group over 60; it develops in the early or later periods of life. Symptomatic arterial hypertension caused by atherosclerosis (sclerotic, predominantly systolic hypertension), kidney disease, or other causes may also occur.
The normal level of blood pressure varies depending on the age in small limits - in 60-69 years it is on average (130 / 80-135 / 80 mm Hg), in 70-79 years - (135-140 / 80- 85 mm Hg), and in 80-89 years - (135-140 / 85-90 mm Hg). Increase in blood pressure more than 155/95 mm Hg for people over 60 years should be considered arterial hypertension, and not a manifestation of purely age-related changes in the cardiovascular system and neurohumoral mechanisms regulating its functions.
[How is hypertension manifested in the elderly?
Arterial hypertension in the elderly, developing in later age periods (mainly in the 7th decade), is characterized by relatively poor subjective symptoms. Often, patients complain of general weakness, noise in the head and ears, shakiness of the gait and very rarely a headache. More rare and less pronounced than in middle-aged people are hypertensive crises. This clinical manifestation of the disease is explained by a decrease in the overall reactivity of the organism, in particular, the reactivity of the nervous system.
At the same time, severe functional shifts in a number of organs and systems, especially in the cardiovascular, kidney, and central nervous system can be observed in such patients. Deep changes in the vascular wall as a result of atherosclerosis cause a relatively easy onset development of cerebral and coronary circulation insufficiency, blood supply of the kidneys.
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How is hypertension treated in the elderly?
Hypotensive drugs are prescribed primarily with diastolic hypertension.
Indication for hypotensive therapy is arterial pressure exceeding (170/95 mm Hg), especially if there are complaints of dizziness, temporary deterioration of vision, etc. Treatment of such vascular hypertension is necessary to prevent the development of nephrosclerosis, cerebral and coronary insufficiency etc.
The agent most often used to treat hypertension in people over 60 years of age is monotherapy: beta-blockers or diuretics. Before assigning beta-blockers it is necessary to find out whether there are any contraindications to them: heart failure, bradycardia, heart block or bronchospasm, beta-6 agents are well tolerated and do not cause orthostatic hypotension. Several groups of beta-blockers are known:
- noncardioselective without sympathomimetic activity (anaprilin, obzidan, timolon);
- noncardioselective with partial sympathomimetic activity (vine, tracicore);
- cardioselective (cordanum, betalk, atsnolol).
If hypertension in elderly people is combined with angina pectoris, it is expedient to use anaprilin, vetch. At violations of the heart rhythm - cordanum, anaprilin. In patients with chronic respiratory diseases, it is desirable to use cadioselektive beta-blockers (betalk), which usually do not cause bronchospastic reactions.
In diabetes mellitus, it is not necessary to use non-selective beta-radiotherapy without partial sympathomimetic activity (obzidan), the same drugs are contraindicated in peripheral circulation disorders (Raynaud's syndrome, obliterating ennarteritis, arteriosclerosis of the vessels of the lower extremities).
In recent years, hypertension in elderly people is treated with the use of calcium antagonists:
- dihydropyridine derivatives - nifedipine (corinfar, kordafen-phenitidine);
- Benzothiazema derivatives - diltiazem (cardiope)
- derivatives of phenylalkylamine - verapamil (isoptin, finaptin);
- in geriatric practice, nifedipine is most often prescribed, especially shown in combination with beta-blockers (cordanum, vine), vasodilators (apsissin).
For the treatment of elderly patients, a combination of corinfar with vine (pindopone) is effective, if necessary with the addition of loop diuretics (furosemide) or potassium-sparing diuretics (triamterene, veroshpiron).
A nurse caring for a patient with hypertension should have a clear idea of the effect of antihypertensive drugs on the level of blood pressure. It is necessary to reduce pressure and ease the work of the heart, improve blood supply to organs. However, you can not allow and overdose of these drugs, a significant reduction in blood pressure, which can give a negative effect.
Do not always bring to the attention of the patient the dynamics of blood pressure and inform him of its high level. Even a small increase in the level of blood pressure in many patients causes anxiety, oppression, negatively affecting the state of neuro-regulatory mechanisms. When assisting a geriatric patient during a hypertensive crisis, the use of warmers (to prevent burns with reduced skin sensitivity), an ice bladder (to prevent hemodynamic disorders in the vessels of the brain) should be avoided.
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