In the western world, hypertension afflicts many adults. The manual, "Essentials of Clinical Geriatrics," 4th ed., estimates that 40 to 50 percent of the geriatric population has hypertension and up to 90 percent of these cases do not trace back to a single, specific cause.
Identification
We define hypertension as blood pressure that has a systolic reading of 140 mm Hg and above with a diastolic measurement of 90 mm Hg and above. However, the elderly population often have a blood pressure reading of 140mm Hg/ <90mm Hg. Referred to as isolated systolic hypertension, this aberration accounts for more than two-thirds of the cases in the elderly, according to The Merck Manual of Geriatrics, 2010.
Significance
Associated with heart attacks, heart failure and strokes, hypertension raises the risk factor for these possibly fatal diseases and events. Detecting and treating hypertension in the elderly helps prevent these cardiovascular illnesses. Maintenance of cardiac health adds quality to a person's life.
Etiology
Secondary hypertension occurs as a result of another condition. Kidney disease, Cushing syndrome, pheochromocytoma, malformations of the heart, estrogen use and hyperthyroidism represent a few. Primary hypertension means having high blood pressure without a predominating illness.
Misconceptions
In the elderly, the incidence of hypertension jumps in spite of the fact that some people do not have any of these pre-disposing factors aside from arteries that stiffened up and lost their elasticity. According to a PubMed article addressing hypertension in the elderly, hardening of the arteries may be directly linked to diet. Combine that information with the low incidence of hypertension in the elderly population of the eastern world and the western lifestyle arises as the culprit. That reflects a diet high in animal fats, a sedentary lifestyle and the cumulative effects of smoking. These effects accumulate after years of living in a culture that has deleterious effects on the body.
Solution
The Seventh Report of the Joint National Committee, JNC7, 2003 outlines the recommended management of treatment of hypertension in the elderly. According to the Merck Manual of Geriatrics, 2010, the report says a good goal for diastolic blood pressure is between 60mm Hg and 90mm Hg, less if the person also has diabetes or a chronic kidney disorder. The systolic blood pressure needs to go below 140mm Hg and maintain that level. To that end, medication and lifestyle modifications need implementation. Diet should be adjusted to lower saturated fats, sodium, and sugar while adding mild exercise. The JNC7 further states that while mortality rates remain unchanged in this population with this treatment, the incidence of stroke reduces by 30 to 40 percent, the incidence of heart attack lowers 20 to 25 percent and the chance of heart failure declines by 50 percent. In short, with this treatment the elderly are less likely to die from illness related to hypertension.
References
- Essentials of Clinical Geriatrics, 4th ed., Robert L. Kane, et al; 1999
- Merck Manual of Geriatrics: Hypertension; 2005
- PubMed, U.S. Library of Medicine: Hypertension in the Elderly; 1987
- Seventh Report of the Joint National Committee, 2003
