Hypertension in the elderly
Summary/Definition
When blood pressure (BP) is elevated, systolic BP (upper) is greater than 140 mmHg and diastolic BP (lower) is greater than 90 mmHg. This condition is a major risk factor for brain stroke, coronary artery disease and other cardiovascular diseases. It is important to take long-term and comprehensive measures to manage elevated BP, as elevated blood pressure increases the risk of mortality. The elderly are most characterised by an increase in systolic BP. This is due to ageing – the elasticity of blood vessels deteriorates, which leads to their stiffness, and diastolic BP tends to decrease after a certain age. At the same time, elderly people have high diurnal BP fluctuations due to the deterioration of the autonomic nervous system’s ability to maintain homeostasis. Orthostatic hypotension or postprandial hypotension is more common than it occurs in young adults. An elevated BP can be divided into primary and secondary depending on the cause. Primary arterial hypertension, also called hypertension, is characterised by high BP for which the cause is unknown. It is common in most patients with hypertension. Secondary arterial hypertension, on the other hand, develops due to other diseases such as kidney disease, adrenal hyperplasia, sleep apnoea syndrome, certain congenital heart defects and other pathologies. Secondary arterial hypertension can also be caused by taking certain medications. Risk factors for elevated BP are age, heredity, obesity, low physical activity, smoking, excessive salt intake, stress and other factors.
Symptoms
The most common associated symptom of high BP is headache. However, in acute arterial hypertension and in the absence of significant symptoms, this condition is difficult to diagnose.
Diagnostics
The diagnosis of hypertension in the elderly is similar to that of high BP in young adults. To make the diagnosis, blood pressure measurements are taken at 1-2 minute intervals. The diagnosis of high BP is confirmed if systolic BP (upper) exceeds 140 mmHg or diastolic BP (lower) exceeds 90 mmHg when several measurements are averaged. Specific body conditions in the elderly can affect the accuracy of measurements. For example, brachialis arthritis (joint disease of the elbow) can lead to overestimation of actual blood pressure readings. If there is stenosis in the subclavian artery due to atherosclerotic plaque, pseudohypotension may also be observed. Therefore, for accurate diagnosis in the elderly, it is necessary to measure the pressure in both arms, as well as measurements in different body positions (sitting, lying down) and taking into account the time after meals. Given the changes in circulatory dynamics and the weak autonomic nervous system response in the elderly, it is also important to take measurements several times during the day, including measurements after meals and while standing.
< Table: Classification of adult blood pressure levels. >
| Classification | Systolic BP (mmHg) | Diastolic BP (mmHg) |
| Norm | <120 | <80 |
| High-normal BP | 120~139 | 80~89 |
| High BP 1 degree | 140~159 | 90~99 |
| High BP 2 degree | ≥160 | ≥100 |
| Systolic hypertension | ≥140 | <90 |
* If you visit the doctor more than twice each time, the average measured blood pressure is used as the basis for the assessment.
Treatment and course of the disease
Untimely treatment of high blood pressure (BP) is associated with an increased risk of fatal outcomes such as coronary heart disease, stroke, cerebral infarction, haemorrhage, aortic aneurysms and other conditions. Effective and proper treatment plays an important role as complications arising from a heart attack or brain haemorrhage, reduced heart function, impaired kidney function due to arterial degeneration and blood vessel abnormalities in the eye and other factors reduce the quality of life. The elderly often have a reduced ability to metabolise drugs, requiring closer monitoring of treatment duration and dosage due to their accumulation in the body. The measurement of blood pressure is one method of treatment. In elderly patients, medications are usually started at low doses compared to young adults. Medication therapy includes diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and other drugs. In addition to drug therapy, lifestyle changes are recommended that include physical activity, smoking cessation, healthy diet, abstinence from alcohol and weight control.
