Hypertension and Aging

Hypertension Occurs More Often in the Elderly

Hypertension negatively affects circulation in the brain, heart and kidneys by stressing the workload of the heart. The incidence of hypertension increases with age. In the United States, hypertension is more prevalent in african-americans than in whites. Organ damage related to hypertension is worse in african-americans than any other group.

Symptoms of Hypertension

How can you tell if a loved one has hypertension? What are the symptoms of hypertension? Hypertension is a silent disease, usually discovered through a physical examination. Blood pressure readings are taken to identify the symptoms of hypertension. When the top number of millimeters of mercury is higher than 140 mm Hg (systolic reading) and the bottom number is higher than 90 mm Hg (diastolic reading), there is cause for concern.

Stages of Hypertension

Hypertension is classified by type, cause, and level of severity. There are four stages of hypertension. The levels are determined by blood pressure tests of both arms. The higher reading of the two tests is used to determine the stages of hypertension.

Stage 1 hypertension: 140-159/90-99 mm Hg
Stage 2 hypertension: 160-179/100-109 mm Hg
Stage 3 hypertension: 180-209/110-119 mm Hg
Stage 4 hypertension: > 210/> 120 mm Hg

Types of Hypertension

Primary Hypertension

The most common of all types of hypertension, primary hypertension can caused by many factors including:

1. Genetic predisposition
2. Obesity and high levels of circulating insulin
3. Environmental stress
4. Vessels that have lost elasticity

Primary hypertension develops when there is an increase in cardiac output and/or an increase in peripheral resistance in the blood vessels.

Secondary Hypertension

Secondary hypertension is a type of hypertension caused by other factors, which must be treated so that a person's blood pressure elevation can be reduced. Common causes of secondary hypertension include:

1. Endocrine disorders
2. Renal disorders
3. Neurological disorders
4. Medications
5. Tyramine-containing foods (aged cheese, chicken liver, yeast, beer, wine)
6. Cocaine use
7. Acute stress like: sickle cell crisis, burns, hypoglycemia, etc.
8. Pregnancy
9. Increased blood volume/too much body fluid retention

White Coat Hypertension

With White Coat Hypertension, a person's blood pressure rises in response to the blood pressure test itself and because of a person's contact with the healthcare worker. (A person's blood pressure level must be monitored several times during a single day if white coat hypertension is suspected in order to rule out the real condition of high blood pressure.)

Isolated Systolic Hypertension - ISH

Isolated Systolic Hypertension is identified when the blood pressure test results in a reading with the top number (systolic) over 140 mm Hg, but the bottom number (diastolic) remains under 90 mm Hg. Isolated Systolic Hypertension occurs in about 25 percent of people over 80 years old. Isolated Systolic Hypertension is due to the blood vessels loosing their elasticity.

Malignant Hypertension

Malignant Hypertension is identified when the diastolic reading in the blood pressure test is over 120 mm Hg. Malignant Hypertension occurs mostly among people who are 40-50 years old. If such a test result occurs for someone under 30 years old or over 60 years old, secondary hypertension should be considered. A reading like this occurs when a high blood pressure condition goes untreated.

Treatment of Hypertension

The goal of hypertension treatment is to get to a blood pressure reading of 135-140/85-90 mm Hg. Before determining the right medication to treat hypertension, lab tests must be done as well as an electrocardiogram to review heart function.

Lab Tests for Hypertension

Typical lab tests for hypertension include:

complete blood count
cholesterol
sodium
potassium
bicarbonate
chloride
glucose
blood area nitrogen
creatinine
uric acid
calcium

Drugs Used to Treat Hypertension

Typical drugs used to treat hypertension include:

Diuretics - diuretics have been prescribed for more than 30 years, and are widely used today to treat hypertension in conjunction with lifestyle modifications. Diuretics promote fluid passing out of the body.
Vasodilators - Vasodilators are commonly used with diuretics and beta blockers to reduce peripheral vascular resistance.
Beta Blockers - The next most widely used type of drug used to treat hypertension after diuretics. Beta Blockers decrease the stress on the heart, and basically smooth out the stresses in the blood pumping system by reducing peripheral vascular resistance.
ACE inhibitors - ACE inhibitors are used to lower peripheral vascular resistance by affecting complex enzymes.
Calcium Channel Blockers - Calcium Channel Blockers are used to block calcium from entering the smooth muscle, causing vasodilation and decreased peripheral vascular resistance.

Tips for Medical Management of Hypertension

Over treatment of hypertension can be dangerous, leading to Hypotension. Hypotension (low blood pressure) may result in falls.
It is important to obtain a blood pressure test while the person is standing.
Orthostatic Hypotension occurs when someone stands up and their blood pressure drops 10 points (10 mm Hg). This may cause one to fall.
It is important to take a blood pressure test about one hour after eating. After a meal, a hormone is released that dilates the blood vessels and causes one's blood pressure to decrease.
Any headaches, dizziness, or double vision/blurred vision should be immediately reported, as these are late danger signs of high blood pressure that may result in a stroke if not treated immediately.
Blood pressure drugs should not be withdrawn, and no doses should be skipped without doctor's orders. The body adjusts to and depends on the drugs.
If you monitor your blood pressure at home, periodically validate the readings at your doctor's office.
A cuff that is too small for your arm will result in a blood pressure reading that is higher than the real pressure.

Hypertension Risk Factors

The following conditions and behavior can contribute to an increased risk of hypertension:

Obesity
Smoking
Lack of exercise
Excessive alcohol use
Diabetes mellitus

Prevention of Hypertension

Once hypertension is diagnosed, it can usually be controlled. Thus, the many potential negative outcomes of unmanaged high blood pressure such as strokes and heart attacks can be prevented or at least reduced in severity.

Lifestyle Modifications to Prevent Hypertension

Lifestyle modifications reduce the amount of medication that must be used to control hypertension.

Examples of lifestyle modifications for hypertension prevention are:

Weight reduction
Sodium restriction (reduce prepared/canned/fast foods and use of salt in food
Decrease intake of saturated fats (use turkey bacon instead of pork bacon; eat skinless chicken)
Regular exercise (aerobic-type)
Restrict alcohol
Restrict caffeine
Relax
Consult your doctor about vitamins and potassium, magnesium, as well as calcium supplementation
Quit smoking.

Commitment to the Health of Elderly Nursing Home Residents

Nursing home lawyer Jeffrey H. Rasansky is committed to improving the health and well being of nursing home residents and the elderly. While hypertension and high blood pressure are common in elderly nursing home residents, they should be monitored and controlled to prevent heart attacks, strokes or even death. If you feel a loved one has suffered due to the neglect or negligence of their nursing home staff, contact an experienced nursing home lawyer at the Law Offices of Jeff Rasansky. We can help.

Jeff Rasansky is licensed to practice before all state courts in Texas, the United States District Courts in the Northern and Eastern Districts of Texas and the Fifth United States Circuit Court of Appeals.

Click here to contact The Law Offices of Jeff Rasansky.