Download Hypertension in elderly

Dr. Mehdi Reza Emadzadeh
Department of cardiology
Mashhad University of Medical Science
From a physiologic standpoint human aging is
characterized by progressive constriction of
the homeostatic reserve of every organ system
HOMEOSTENOSIS
Principles of geriatric medicine
• Individuals become more dissimilar as they
age.
• An abrupt decline in any system or function
is always due to disease and not to “normal
aging”.
• Normal aging can be attenuated by
modification of risk factors.
• Healthy old age is not an oxymoron
Other Concepts
• Disease presentation is of ten atypical in the
elderly.
• Because of decreased physiologic reserve,
older patients often develop symptoms at an
earlier stage of their disease.
• Since many homeostatic mechanisms may
be compromised concurrently,there are
usually multiple abnormalities amenable to
treatment.
• Many findings that are abnormal in younger
patients are relatively common in older
people.
• Because symptoms in older people are often
due to multiple causes,the diagnostic “law
of parsimony” often does not apply.
• Because the older patient is more likely to
suffer the adverse consequences of disease,
treatment __ and even prevention__ may be
equally or even more effective.
EPIDEMIOLOGY
• The population 65 years and older has
grown from
20 million
in 1970
to
35 million
in 2000
and there will be
69 million
by 2030
• At present 1 in every ten people is 60 years or
older. By 2050 this is projected to become 1 in
every 5.
• The number of 100 years and older is projected to
increase from 145000 in 1999 to 2.2 million
by2050
• In this older population cardiovascular
disease plays a significant role and is the
most common cause of morbidity and
mortality.
• The overall cost of treating cardiac disease
in people older than the age of 65 years was
estimated at $58 billion in 1995.
SYSTEMIC HYPERTENSION IN THE ELDERLY
prevalence and incidence
• - BP>140/90 occurs in half to two thirds of
people older than 65y and in 75% of people
older than 80y.
• - Systolic hypertension becomes more
prevalent with aging.
• - “Isolated” systolic hypertension, without
elevation of diastolic blood pressure, is
present in about 8 percent of sexagenarians
and more than 25 percent of the population
older than 80 years of age.
TREATMENT
• - The need for treatment of hypertension in
the elderly.
• - There is cardiovascular benefit for
treatment of systolic or diastolic blood
pressure in the elderly.
• - Combination of drug regimens including a
diuretic are usually required to approach
blood pressure targets.
• - Different combination of pharmacological agents
may have advantages based on the patients,
concomitant diseases, genetics, or risk factors.
• - Dihydropyridine calcium channel blockers 
greater stroke benefit.
• - ACE inhibitors  cardiac benefit, primarily in
men.
• NSAIDS, as well as cox-2 selective NSAIDS.
• Thiazide diuretics.
• - Lower initial drug dosages and slower
medication titration, as well as the need for
monitor for postural hypotension.
• - Postural hypotension of greater than 20 mmHg
or 20 percent of systolic pressure is a risk factor
for falls and fractures that carries significant
morbidity and mortality.
• - Diuretic therapy.
• - Postprandial decline in both systolic and
diastolic blood pressure.
CURRENT CONTROVERSIES
• - Target blood pressure for systolic blood
pressure in the very old.
• - Differences in central versus peripheral
blood pressure.
• - Lifestyle modifications.
• Impact of blood pressure treatment on
development of dementia.