Older people hypertension

Q9 Thiazides are considered first-line drugs in the treatment of hypertension in older people. They are also used in mild heart failure and to inhibit kidney stone formation in hypercalciuria, in addition to their use in treatment of nephrogenic diabetes insipidus. 

Doctors have noted this tendency for many years, but the definitive study was done in 2003. Investigators from the United States and Japan collaborated in the work that determined that significant morning surges in blood pressure present a major risk of stroke for older patients with hypertension. Previous work established a similar risk for older people arising from an afternoon siesta. It s scary to think that taking a nap can actually be hazardous to one s health ... 

Unfortunately, the percentage of hypertensive older men and women being treated is lower than doctors would like to see. And of those receiving treatment, the number of older people achieving their blood pressure goals is far from desirable. 

Hypertension often presents as isolated systolic hypertension in the elderly. Epidemiologic data indicate that cardiovascular morbidity and mortality are more closely related to SBP than to DBP in patients aged 50 years and older, so this population is at high risk for hypertension-related target-organ damage. Although several placebo-controlled trials have specifically demonstrated risk reduction in this form of hypertension, many older people with hypertension are either not treated or treated yet not controlled. ... 

Starting doses of ACE inhibitors should be low, with even lower doses started in patients at risk for orthostatic hypotension. Acute hypotension may occur at the onset on ACE inhibitor therapy. Patients who are sodium- or volume-depleted, in heart failure exacerbation, very elderly, or on concurrent vasodilators or diuretics are at high risk for this effect (see the Hypertension in Older People and Patients at Risk for Orthostatic Hypotension sections under Special Populations ). It is important to start with half the normal dose of an ACE inhibitor for all patients with these risk factors and to use slow dose titration. The risk of serious adverse reactions overah can be decreased approximately 50% by using a 6-week time interval between dose increases versus a 2-week interval. ... 

Hypertension is defined as persistently high systemic arterial blood pressure above 140/90 mmHg, although this does depend on age. For older people, a more realistic... 

The decrease in the size of the brain with age in normal persons is the result of a decrease in synapses, not neurons. High stress and hypertension contribute to intellectual decline, again related to loss of synapses. Memories are believed to be the result of long-term potentiation (LTP) of neurons. It declines with age. With aging, there is a decrease in the number of dendrites (Coleman and Flood, 1987). Synaptic deterioration with aging causes the loss of memory, but neuronal death is the more likely cause of AD. Older people who continue to be mentally active are less likely to suffer from memory loss. Neo cortical loss of synapses in patients with AD is correlated with the degree of cognitive impairment (DeKosky and Scheff, 1990 Terry et al., 1995). 

The standards issue becomes most problematic with patients who have multiple problems. It may be sensible to delay the treatment of pneumonia, for instance, while more urgent investigations and treatments are instituted. An additional problem is that of combining multiple treatments with the risk of adverse drug events and actually producing harm through the application of standard procedures. Wachter (2006) has argued that quality measurement is bewildered by the patient with multiple conditions, which is, of course, most people admitted to hospital and many older people outside hospital. He considers a hypothetical 79-year-old woman with five common diseases hypertension, osteoporosis, osteoarthritis, type 2 diabetes mellitus and chronic obstructive pulmonary disease ... 

Lead is a ubiquitous metal in the environment, and its adverse effects on human health are well documented. The nervous system is an important target of lead toxicity, which causes adverse eognitive, mood, and psychiatric effects in the central nervous system of adults eauses various peripheral nervous system effects and has been linked to neurodegenerative diseases. Lead exposure also causes anemia, nephrotoxicity, a variety of adverse reproductive and developmental effects, smaU increases in blood pressure and an increased risk of hypertension particularly in middle-aged and older people, and various effects in other organ systems, including ioint pain and gastrointestinal pain (ATSDR 2007 EPA 2012 NTP 2012). 

Cervilla, J. A., Prince, M., Joels, S., Lovestone, S., Mann, A. (2000). Long-term predictors of cognitive outcome in a cohort of older people with hypertension. The British Journal of... 

On the basis of the standard presented above, the incidence of obesity is estimated as low before 20, rising sharply after 30, and reaching a maximum in the sixth decade. The incidence of obesity drops after the sixth decade because obese people die younger, and older people spontaneously reduce their food intake. Approximately 30% of the middle-aged American population is obese. In addition to the cosmetic disadvantages, the hazards of obesity are numerous. The incidence of diabetes, atherosclerosis, and hypertension is greater in the obese. The relationship between these diseases and obesity is discussed in other sections of this book. 

Educating the Patient and Family Nurses can do much to educate others on the importance of having their blood pressure checked at periodic intervals. This includes people of all ages because hypertension is not a disease seen only in older individuals. Once hypertension is detected, patient teaching becomes an important factor in successfully returning the blood pressure to normal or near normal levels. 

Q4 For young people with essential hypertension, either a beta-blocker fi-blocker) or an ACE inhibitor is recommended. For older patients, the medication of choice for hypertension is either a diuretic or calcium channel blocker. 

Until recently, medical authorities considered WCH to be benign. The Japanese investigators wondered whether WCH might signal the future development of actual hypertension. Over a period of eight years, they compared patients with WCH with those whose blood pressure was normal in the doctor s office. Nearly twice as many WCH patients went on to develop hypertension as did people with normal blood pressure. Risk of future hypertension was greater for men and for older and/or overweight individuals. 

Heart authorities in the United States, the United Kingdom, Australia, and just about everywhere else urge citizens to cut back, way back, on salt and sodium consumption. For many people, this can help them to control hypertension. That s especially true for blacks and older men and women, all of whom are more salt sensitive than others. About 25 to 50 percent, perhaps more, of people with hypertension—not necessarily mildly elevated blood pressure—are sodium sensitive. Blacks have a higher rate of sodium sensitivity, but that leaves a lot of men and women who are not. 

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