Hypertension in an aging population: problems and opportunities

Article Abstract:

Those aged 65 and older constituted 11 percent of the population of the US in 1980, and this percentage is growing. In that same year, the elderly accounted for 34 percent of health care expenditures and occupied 40 percent of hospital beds. These numbers will undoubtedly increase in proportion to the percentage of elderly. A symposium on high blood pressure (hypertension) in the aging population was held to examine the current research on this condition, which is the most common medical problem of older people. There is growing evidence that antihypertensive therapy reduces deaths from heart failure and stroke, and is especially effective for those over 60 years old. Two studies have demonstrated a reduction in strokes, and another found a decrease in overall cardiovascular mortality. However, no studies have found a decrease in complications of atherosclerosis (fatty deposits in the arteries) in this group. In addition, antihypertensive therapy with thiazide diuretics and beta blockers may actually contribute to these problems. Isolated systolic (the force against which the heart contracts) hypertension probably causes enlargement of the left ventricle, a risk factor for heart disease. In addition, the reduction in mass, circulation, and filtration, as well as the ability of the kidney to respond to changes in sodium and water intake are problems facing elderly hypertensive patients. Changes in body mass and kidney function can also affect how patients respond to drug therapy. Elderly patients frequently have other illnesses that influence the choice of drug therapy, and problems of mental processes and depression should be considered. This symposium presented a series of articles that addressed these various issues. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Aged, Elderly

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Epidemiology, pathophysiology, and management of isolated systolic hypertension in the elderly

Article Abstract:

Diastolic blood pressure has been a primary consideration in studies of high blood pressure (hypertension), but more recent studies have found that high systolic blood pressure (defined as 160 or more millimeters of mercury, mm Hg), even when the diastolic pressure remains within the normal range (isolated systolic hypertension, ISH), predicts complications, especially coronary artery disease, stroke, and congestive heart failure, better than diastolic pressure. The prevalence of ISH increases with age, and affects over half of all men and two thirds of women aged 65 to 89 years. ISH among middle-aged patients also indicates increased risk of coronary artery disease and death from all causes. It is not yet known whether treatment of ISH will reduce cardiovascular risks for the patient. ISH is not an inevitable consequence of aging, and is related to stress, lack of physical exercise, weight-gain, and dietary habits. The declining elasticity of aging blood vessels is also implicated. Some physicians do not treat ISH among elderly patients, and others use a higher cutoff than 160 mm Hg. However, elderly patients can be treated safely and effectively with drugs now available. Calcium channel blockers and angiotensin-converting enzyme inhibitors are both effective and produce fewer side effects than older drugs. Data from a large-scale trial will be available during soon, which should help to define the efficacy of drug therapy in reducing illness and death from ISH. It is recommended that ISH be treated first with dietary changes (perhaps including calcium supplementation) and weight reduction. If these measures fail, drug therapy should be considered if systolic blood pressure remains over 180 mm Hg. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Practical considerations in treating the elderly hypertensive patient

Article Abstract:

Although there is little information on the treatment of high blood pressure (hypertension) in octogenarians, large-scale studies have found that treatment can benefit patients with hypertension who are between the ages of 65 and 80. Older patients are at greater risk for heart attack and stroke, and are less likely to survive these events than younger patients. Physiological differences also distinguish older from younger patients in a number of ways that affect treatment. In the elderly, drug dosages should be changed slowly, and drugs that cause changes in blood pressure related to posture should be avoided. The risks of antihypertensive therapy are potentially greater among older patients. Older patients are also more likely to have other illnesses that affect the care and treatment of hypertension. Medication taken for arthritis can interfere with antihypertensive therapy. Other heart medications, such as digoxin and antiarrhythmic drugs, can increase the adverse effects of calcium channel blockers on the heart. Because heart attacks and strokes occur most often in the hours after awakening in the morning, a long-acting, once-a-day drug such as amlodipine, a calcium channel blocker, is useful. Other measures, such as salt restriction, weight loss, and avoiding excessive alcohol consumption are all effective in treating hypertension. Calcium channel blockers are effective across a broad range of patients. Thiazide diuretics are highly controversial. Beta blockers, alpha blockers and angiotensin-converting enzyme inhibitors can be used selectively in elderly hypertensive patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects

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