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Apr 25, 2011

Hypertension Treatment in Older Individuals

Updated guidelines for the diagnosis and treatment of high blood pressure in the elderly.

The population of older individuals in the United States is rapidly increasing, in part due to significant advances in medicine helping more people to live longer. Unfortunately, there are certain medical conditions that are extremely common in older individuals as a result of aging, such as hypertension, which can prove difficult to treat.

High blood pressure, also known as hypertension, is a condition affecting roughly 2/3 of older individuals. As people age, arteries harden, which can slow blood flow and cause an increase in systolic blood pressure. While extremely common, high blood pressure can be difficult to treat in older individuals as a result of many factors. While common, few research studies have included individuals over 65 years of age, and those that do often do not report age-specific results. This had led to lack of evidence supporting precise guidelines for the treatment of hypertension in older individuals. Moreover, many elderly people have multiple health conditions, which can often limit or complicate treatment options.

As a result, the American College of Cardiology Foundation and American Heart Association recently collaborated with many partners to compile the most current guidelines for treating hypertension in older individuals, published in January of 2011. According to these guidelines, diagnosis for hypertension should be based on at least three separate blood pressure measurements taken during separate office visits. This is extremely important for both patients and providers to be aware of, as blood pressure levels can greatly fluctuate in older individuals.

Once multiple blood pressure measurements have been taken and an elderly patient is diagnosed with hypertension, there are many factors that should be taken into consideration when deciding on treatment, such as possible causes, organ damage, other risk factors for heart disease, and barriers to treatment adherence. Further tests should also be performed on the patient, including urinalysis, blood chemistries, cholesterol, blood sugar, and an electrocardiogram. Quality of life is also extremely important, and the advantages and disadvantages to all forms of treatment should be taken into account for each individual patient.

Once the factors mentioned above are measured, treatment options for hypertension in elderly patients can include lifestyle modification, drug therapy, or a combination of both. When prescribing drugs, elderly patients should start out taking the lowest dose, and gradually increase dose levels over time. It is important to avoid excessive blood pressure reduction in older individuals, as this can be equally as dangerous for their health.

Additional research is needed regarding hypertension in older individuals, but the above guidelines will help standardize treatment in this population, and prove extremely useful for healthcare providers as well as patients. 

Questions for You to Consider

  • Why should blood pressure be measured on at least three separate occasions to diagnose hypertension in older individuals?
  • There are many factors that can impact blood pressure measurements in older individuals. For example, white-coat hypertension is common among older individuals, where blood pressure temporarily increases in patients due to the stress of being seen by a healthcare provider. At least one type of home blood pressure monitoring is recommended to rule out this phenomenon. Other factors that can affect blood pressure in older individuals include taking measurements while patient is standing vs. sitting, as well as the time allowed for the patient to rest before taking blood pressure.
  • Why is hypertension so common in older individuals?

  • As arteries harden with age, systolic blood pressure increases, which measures the amount of pressure exerted on arteries and vessels by blood pumping through the body. The normal range for systolic blood pressure is 90-120mmHg in adults, and under 140mmHg in older individuals.

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