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Hypertension in the Elderly Guidelines

July 29, 2021

Serving as a PCS caregiver is a challenging but rewarding experience. With your help, your loved one can stay at home instead of going to a nursing facility. He or she puts a lot of trust in you to provide care, and educating yourself on various conditions is critical.

Along with keeping your loved one company and assisting with activities of daily living, you need to stay on top of his or her health needs. That includes blood pressure management.

It’s important to understand hypertension and the danger of leaving it untreated. You also need to review blood pressure goals and options for treating hypertension. Then, you’ll be ready to tend to your loved one’s needs.

First, take a closer look at what hypertension is.

What Is Hypertension?

Each time your heart beats and rests, it creates the force needed to move blood through your body. The blood travels through arteries, veins, and capillaries to deliver oxygenated blood to your organs and tissues.

Blood pressure is the term used to describe the two types of pressure the heart creates. First, there’s systolic pressure. The heart creates this force with each beat to push blood through the circulatory system.

Then, there’s the diastolic pressure. This is the force created when the heart rests. The pressure brings blood and oxygen into the heart. Since the heart is always pumping or resting, the pressure is constant.

Blood pressure is measured in millimeters of mercury (mmHg) and contains two numbers. The top number is the systolic pressure, and the bottom number is the diastolic pressure.

Hypertension is diagnosed when the force is higher than it should be. The extra pressure pushes against the blood vessels in your circulatory system and can cause a wealth of medical problems. You can have hypertension if your systolic pressure, diastolic pressure, or both are higher than the recommended levels.

As a caregiver, you’ll need to regularly monitor the patient’s blood pressure to see where it falls. There are five categories: normal, elevated, stage one hypertension, stage two hypertension, and hypertensive crisis. The blood pressure reading will give you insight into your loved one’s overall health and level of risk.

The ranges are:

·        Normal blood pressure

o   Systolic pressure less than 120 mmHg and

o   Diastolic pressure less than 80 mmHg

·        Elevated blood pressure

o   Systolic pressure between 120-129 mmHg and

o   Diastolic pressure less than 80 mmHg

·        Stage one hypertension

o   Systolic pressure between 130-139 mmHg or

o   Diastolic pressure between 80-89 mmHg

·        Stage two hypertension

o   Systolic pressure 140 mmHg or higher or

o   Diastolic pressure 90 mmHg or higher

·        Hypertensive crisis

o   Systolic pressure above 180 mmHg and/or

o   Diastolic pressure above 120 mmHg

While anything above normal blood pressure is a health risk, a hypertensive crisis is an emergency. If your loved one is experiencing a hypertensive crisis, call a doctor immediately.

It’s possible to have high blood pressure and not show symptoms. However, it’s quite dangerous, which is why many in the medical community refer to it as the “silent killer.” Let’s dig in and look at why treating hypertension is critical.

Why Is Treating Hypertension So Important?

Untreated hypertension is associated with numerous dangerous health conditions. These conditions can reduce the quality of life and can be fatal.

For instance, you can develop cardiovascular disease and circulatory problems if you don’t treat hypertension.

Cardiovascular Disease and Circulatory Issues

Hypertension puts excess strain on the circulatory system. The added pressure damages the lining of the arteries, making it difficult for blood to flow. This forces the heart to increase its workload.

Between the damage and the increased workload, many people with untreated hypertension develop cardiovascular disease and other serious circulatory problems.

Cardiovascular disease and circulatory problems are dangerous at any age. However, elderly people are at high risk for having catastrophic health problems when dealing with cardiovascular and circulatory issues.

As you age, your heart and blood vessels weaken. These changes combined with hypertension can be a deadly combination. Basically, you’re taking an already weak system and making it weaker.

Cardiovascular disease and circulatory issues can cause serious health problems. First, you run the risk of suffering a heart attack. Over time, high blood pressure can damage the coronary arteries to the point that they build up with plaque. This causes the arteries to narrow, so there isn’t as much space for blood to flow. If the blockage is big enough, blood will be cut off from the heart, causing a heart attack.

Cardiovascular disease and circulatory problems also put you at risk for a stroke. This occurs when the increased blood pressure damages blood vessels inside the brain. Clogs can appear in the damaged blood vessels, causing a stroke. It’s even possible for the damage to be so great that the vessels burst.

Sadly, heart failure is also possible after developing cardiovascular disease due to untreated hypertension. Hearts aren’t designed to handle the increased workload created by hypertension. Eventually, the heart can become enlarged and no longer able to pump blood throughout the body.

Even the kidneys are at risk when it comes to high blood pressure. The body requires a healthy cardiovascular system to deliver blood to the kidneys. If the arteries located around the kidneys become damaged, you can develop kidney disease. It’s even possible for the kidney to fail.

The arteries in the arms, stomach, legs, and head can also narrow due to high blood pressure. This can lead to peripheral artery disease. Pain and fatigue are common with peripheral artery disease.

Vision Loss

Hypertension can damage the optic nerve and blood vessels in the eyes. It can also cause fluid to build up under the retina. These issues can lead to vision loss.

In addition, suffering a stroke due to hypertension can also cause you to lose your vision. It’s not uncommon for a stroke to damage the optic nerve. A stroke can also impact the part of the brain that processes images.

Cognitive Deterioration and Untreated Hypertension

Cognitive decline is a natural part of the aging process. It’s normal for your loved one to get a bit forgetful as the years pass. However, hypertension can make the problem much worse and cause the decline to accelerate.

Researchers believe that hypertension either alters brain receptors or damages the parts of the brain that handle cognitive functions such as memory. The damage causes cognitive decline to happen rapidly.

Previously, researchers speculated that cognitive decline occurred in people who developed hypertension at a young age. The belief was that having high blood pressure while young and failing to control it would have the largest impact on cognitive function.

However, a study published in the American Heart Association’s Hypertension journal in 2020 has changed the school of thought on cognitive decline and high blood pressure.

Dr. Sandhi M. Barreto of the Universidade Federal de Minas Gerais and his team of researchers studied cognitive information and blood pressure readings from more than 7,000 Brazilian adults. The average age of the participants was 59 when the study started. 

At the beginning of the study, researchers tested each participant in:

·        Memory

·        Verbal fluency

·        Executive function

To determine executive function, researchers measured the participants’ abilities in thinking and reasoning. This included tests to measure concentration, attention, and more.

Along with cognitive function, the researchers evaluated participants’ blood pressure. The evaluation included each person’s history of hypertension, prehypertension, and hypertension control.

The participants returned four years later for a second cognitive function test.

The results were stunning. People with uncontrolled hypertension experienced a faster cognitive decline than others in the study. That includes those who used medication to reduce blood pressure.

But that’s not all. The accelerated decline was present, regardless of how long the blood pressure was elevated. Also, even slightly elevated blood pressure was associated with rapid cognitive decline. The participants who had untreated prehypertension showed a faster cognitive decline than participants in the normal blood pressure range.

Prehypertension is “elevated blood pressure” and is just one step above the normal range. Thus, a small spike can cause your loved one’s cognitive function to decline rapidly. That’s why monitoring and management are so important for caregivers and patients.

Loss of Autonomy

One of the most difficult aspects of aging is the loss of independence. It’s hard to go from doing things for yourself to needing help with activities of daily living and other tasks.

Elderly patients do everything they can to hold onto as much autonomy as possible. That’s why managing blood pressure is important. When elderly people develop medical issues and cognitive problems due to high blood pressure, it’s hard to maintain independence.

At first, patients might need caregivers to help with physical tasks that they can’t handle due to cardiovascular issues. For example, a caregiver will need to step in and assist someone who has suffered a stroke or a heart attack due to hypertension.

Eventually, the loss of autonomy can become even greater as the cognitive decline increases. Memory loss and issues with cognitive function can make even basic tasks impossible to handle.

Let’s look at categories for the elderly when it comes to hypertension. This is a key component to understanding how to manage it.

Categories of Elderly People With Hypertension

Age is important when evaluating hypertension. The medical community has divided people aged 65 and over into two categories.

The “elderly” category is for people between 65-79 years of age. Then, the “very old” category contains people who are 80 and over.

These categories are important because managing blood pressure can become more challenging as patients age. Blood pressure management tends to be more aggressive for those in the “elderly” category compared to people in the “very old “category.

With very old patients, doctors have to measure how well they tolerate blood pressure medications and elevated blood pressure. In the past, it wasn’t uncommon for doctors to avoid managing blood pressure in very old patients.

However,  doctors now find the middle ground between managing blood pressure and minimizing the side effects of medications. In fact,  it’s not unusual for very old patients in nursing homes to take blood pressure medication.

Keep these categories in mind while looking at blood pressure goals for the elderly.

Blood Pressure Goals for the Elderly

Blood pressure goals change as people age. It’s important to keep track of the guidelines for a patient under your care, so you can take action to reduce the blood pressure if needed.

The guidelines vary slightly based on the issuing body. First, let’s look at the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). The guidelines state that elderly patients should keep their blood pressure below 140/90 mmHg. Very old patients need to keep their blood pressure below 160/90 mmHg.

The American Heart Association (AHA) and American College of Cardiology (ACC) also provide guidance on blood pressure thresholds. The most recent update occurred in 2017, and it received a lot of buzz.

In the past, the AHA and ACC set the threshold for hypertension at 150/80 mmHg for seniors 65 and older. However, in 2017, it stopped distinguishing between age groups. Now, it recommends that all adults, regardless of age, maintain a blood pressure that’s lower than 130/80 mmHg.

The American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) last updated their guidelines in 2017. Unlike the AHA and ACC, the ACP/AAFP guidelines address patients over 60. The ACP/AAFP recommends that patients in this age group should be treated if the systolic pressure is 150 mmHg or higher.

Keep in mind that the guidelines are meant for general guidance. However, medical conditions and history are also taken into account when determining the target range for patients.

If you’re unsure of what your loved one’s target range is, speak to his or her physician. The doctor will have the full picture and can provide guidance.

After you determine the proper range, monitor the blood pressure. If your loved one’s blood pressure goes past the threshold, speak to his or her doctor about pharmacotherapy. Let’s take a closer look at what to expect if your loved one takes blood pressure medication.

Pharmacotherapy to Treat Hypertension

If your loved one has hypertension, pharmacotherapy might be an option. This is the use of medications to reduce blood pressure.

Doctors use various medications to manage hypertension, including:

·        Angiotensin-converting enzyme (ACE) inhibitors

·        Angiotensin II receptor blockers (ARBs)

·        Calcium channel blockers

·        Beta-blockers

·        Diuretics

ACE inhibitors and ARBs lower blood pressure by preventing angiotensin from forming. This chemical causes blood vessels to narrow, forcing the heart to work harder.

Calcium channel blockers reduce blood pressure by blocking calcium from entering the arteries and heart. By keeping calcium out, the arteries can relax. That means your heart can pump blood through the body without working as hard.

Beta-blockers are used to reduce the stress on your heart. The medication blocks the effects of adrenaline (epinephrine) in your body. Without an overabundance of adrenaline, your heart won’t work as hard and will beat slower.

Renin inhibitors are another option. This medication slows down renin production in the kidneys. Producing renin is one step in a process that causes blood pressure to rise. Slowing down production reduces blood pressure.

Diuretics are also prescribed for high blood pressure. These pills reduce fluid in the arteries and veins by removing sodium and water from the body. Lowering the fluid also reduces the pressure in the cardiovascular system.

Often, diuretics are used with another blood pressure medication. Doctors like prescribing diuretics because they have fewer side effects and complications than other medications. However, some patients don’t reach their blood pressure goals with just a diuretic.

By prescribing diuretics, doctors can lower the dosage of the other medication. That reduces the risk of side effects.

Find Out If Your Loved One Qualifies for Blood Pressure Medications

When you’re a caregiver, you’re part of your loved one’s personal care team. You’re also an advocate for his or her health.

Get a blood pressure monitor to keep track of the numbers at home. If you notice that the blood pressure is elevated, schedule an appointment with your loved one’s physician. Discuss the blood pressure level with the doctor and ask if your loved one is a candidate for pharmacotherapy.

Be Vigilant and Treat the Side Effects

Blood pressure medications typically do an excellent job of reducing blood pressure. However, they have side effects. Sometimes, side effects go away after a short period of time, but there are times when side effects are long-lasting.

You need to monitor your loved one for side effects after he or she starts taking blood pressure medication. You can treat side effects such as dry cough, diarrhea, or constipation.

You also might need to provide additional support due to side effects. For instance, if your loved one suffers from fatigue and dizziness, he or she will need more assistance.

Find out what side effects you can expect from various blood pressure medications. Pay special attention to the rare but severe side effects that require medical attention.

DRUG SIDE EFFECT PRECAUTIONS

Medication

Mild to Moderate Side Effects

Rare but Severe Side Effects

Special Instructions

 

Angiotensin-converting enzyme (ACE) inhibitors

·        Dry cough

·        Itchy skin

·        Rash

·        Dizziness

·        Metallic taste

·        Decreased taste

·        Sore throat

·        Fever

·        Mouth sores

 

·        Fast or irregular heartbeat

·        Chest pain

·        Swelling of the tongue, face, and neck

·        Elevated potassium levels

·        Kidney failure

·        Severe vomiting or diarrhea

 

Patients require regular monitoring to control serum potassium and creatinine levels.

Angiotensin II receptor blockers (ARBs)

·        Headache

·        Dizziness

·        Fainting Fatigue

·        Vomiting and diarrhea

·        Leg swelling

·        Back pain

·        Respiratory issues

·        Elevated potassium levels

·        Liver or kidney failure

·        Tissue swelling

·        Low white blood cell counts

·        Irregular heartbeat

·        Allergic reaction

Regular kidney function tests are necessary when taking this medication.

Calcium channel blockers

·        Constipation

·        Dizziness

·        Flushing

·        Rash

·        Nausea

·        Headache

·        Swelling in lower legs and feet

·        Heart palpitations

·        Irregular heartbeat

Grapefruit interacts with some calcium channel blockers, so consult with a doctor before eating grapefruit or drinking grapefruit juice.

Beta-blockers

·        Dizziness

·        Fatigue

·        Poor circulation

·        Upset stomach

·        Nausea

·        Diarrhea

·        Constipation

·        Sexual dysfunction

·        Weight gain

·        Difficulty breathing

·        High blood sugar

·        Depression

·        Insomnia

·        Nightmares

Patients with a history of asthma, heart disease, kidney disease, diabetes, or allergic reactions might not be eligible to take beta-blockers.

Renin inhibitors

·        Fatigue

·        Headache

·        Dizziness

·        Diarrhea

·        Stuffy nose

·        Trouble breathing

·        Swelling of the throat, tongue, lips, or face

·        Hives

Renal inhibitors are relatively new, so little is known about long-term use.

Diuretics

·        Increased urination

·        Sodium loss

·        Dizziness

·        Headaches

·        Dehydration

·        Muscle cramps

·        Gout

·        impotence

·        Decreased potassium levels

·        Irregular heartbeat

Regular kidney tests are necessary to check kidney function.

 

Now, let’s look at what you can do to help your loved one reduce his or her blood pressure.

How to Lower Blood Pressure for the Elderly

If you’re caring for an elderly patient with high blood pressure, you can incorporate some changes to help lower it. Both lifestyle and diet changes are beneficial for lowering blood pressure in seniors.

Let’s begin by exploring lifestyle changes.

Lifestyle Changes

Regular exercise is one of the most effective ways to reduce and control blood pressure. If your loved one isn’t currently active, ease him or her into an exercise routine. Ramping up the intensity too quickly could cause an injury or medical problem, so take it slow.

Set a goal of getting up to 150 minutes of moderate physical activity. You can break it up into 30 minutes five days a week or go for smaller increments if needed.

The physical activity should be at a moderate intensity. However, keep in mind that a moderate intensity for a 40-year-old isn’t the same as a moderate activity for an 80-year-old.

Walking and dancing are both excellent activities. However, if your loved one has mobility issues, you can choose exercises that can be performed while sitting. The goal is to get the heart rate up in a safe manner.

If your loved one has medical issues, don’t start an exercise program until getting approval from a physician. The doctor might have some additional ideas or exercises to incorporate.

Diet Changes

Dietary changes can also reduce blood pressure in the elderly. The American Heart Association recommends eating heart-healthy foods such as:

·        Fruits and vegetables

·        Whole grains

·        Low-fat dairy

·        Poultry and fish without the skin

·        Nuts

·        Legumes

·        Non-tropical vegetable oils

Your loved one needs to limit:

·        Saturated fat

·        Trans fat

·        Sodium

·        Red meat

·        Candy and sweets

·        Sugary beverages

You can make sure that your loved one eats and avoids the right foods by following the DASH Diet. DASH stands for Dietary Approaches to Stop Hypertension. You can get meal plans and more by purchasing a book or using online resources.

Your loved one also needs to limit alcohol consumption since it causes blood pressure to increase.

These diet changes will help your family members lose weight. Even losing a few pounds can cause blood pressure to go down.

Now, it’s time to take the next step and find out the right blood pressure range for your loved one. Then, monitor it and take action if needed.


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