How to treat hypertension in elderly people

Treating hypertension in elderly patients is not an easy task because the condition is often characterized with additional illnesses and health complications that make it difficult obtaining accurate and representative blood pressure readings.

Older people often suffer from more variable blood pressure that changes from standing to a seated position or even after having a meal.

To evaluate suspected hypertension on elderly patients the blood pressure readings have to be taken while the patient is seated and while standing. Contrary to the younger people, the diagnosis should be based on more than two high readings when it’s recommended to take 2 or even 3 high readings at separate times.

Patient’s medical history and medical condition should also be taken in consideration. Aggravating factors such as obesity, diabetes, smoking, excessive alcohol or salt consumption, emotional stress and dyslipidemia they all should be thoroughly studied to determine the required treatment.

However, taking the blood readings is not the only required test to determine the kind of treatment the patient should acquire. The physical exam is one of the most important tests when attention must be paid to signs of organ damage and particularly to a hypertensive retinopathy.

The routine should include the heart and peripheral arterial pulse checkups and an auscultation of the carotid arteries and abdomen for bruits.

When it comes to lab tests there are several parameters to analyze as well:

* Electrocardiogram

* Complete blood count

* Urinalysis

* Electrolyte panel

* Fasting glucose levels

* Creatinine level

* Lipid profile

Non-pharmacological treatment

Just like in younger patients a non-pharmacological treatment also can be very effective and beneficial in elderly people. This can include the lifestyle and eating habit changes, reduction or complete stop of smoking, reducing of alcohol intake, lower sodium intake, weight reduction and engaging to the regular aerobic exercise.

Drugs used for treatment

Blood pressure in older patients with comorbidities is treated with the same drug classes that are used to lower blood pressure for younger patients. The aging and health deterioration often determine therapy with two or more drugs to achieve the goal.

As a first-line drug for treatment Thiazide diuretics, Beta-blockers or ACE inhibitors can be used, however, as with any other medication for elderly patients, the key is to start low and go slow.

It’s advised to monitor the older patients for postural hypotension and other possible reactions.

Beta-blockers — Older patients are more sensitive to beta-blockers due to an age-related pharmaco-dynamics. It shows in higher incidence of Bradycardia, which can result in dizziness and falls. It’s recommended that the initial dose of the medication used for treatment, Metoprolol, should be less than 25 mg a day to prevent health complications.

ACE inhibitors – ACE medication, Lisinopril’s recommended dose for the beginning should be 2.5 mg a day.

Calcium channel blockers – CCB medication, Amlodipine, that is also a safe choice, it’s recommended for the beginning 2.5 mg a day.

Possible side effects

When starting a treatment in older people with a new medication, it’s always advised to be very cautious and to be aware of possible side effects. Most of the times, patients already have certain health complications and may be unwilling to take additional drugs to avoid interference between the drugs.

Clear instructions about how to take different medications and what possible side effects to expect many times can avoid unnecessary suffering and better results in the treatment.

Follow-up

To ensure successful treatment of hypertension monthly follow-up should be added into the routine until a blood pressure goal is reached. After that, a regular visit at the doctor’s office every three to four months can ensure an appropriate blood pressure monitoring and the stable blood pressure in older patients.