Hypertension - #13
Take QuizDetermine blood pressure goals in older adults and possible medications.
Clinical Recommendations:
Recommended blood pressure goal in patients >65 years: < 140/90 mm Hg.
Recommended blood pressure goal in patients>65 years with diabetes or chronic kidney disease: < 130/80 mmHg.
Recommended blood pressure goal in patients >80: < 150/80 mmHg.
Considerations when treating:
Treat isolated systolic BP.
Thiazide diuretics are considered first line treatments.
Co-morbidities and risk factors (outlined in Table 1) determine second line treatments.
Combinations of two or more anti-hypertensives may be necessary for those with systolic pressures > 160 mmHg or diastolic pressure > 100 mmHg.
Chosen anti-hypertensive must be titrated slowly to prevent hypotension and other side effects.
Life-style modifications listed in Table 2 should be recommended as part of the management of hypertension. These modifications can be as effective as pharmacological therapies in certain individuals.
Consider the patient’s goals, beliefs, previous experiences with treatment and the cost of medication prior to treating.
Table 2: Life-style modification recommendations. *DASH – Dietary Approaches to Stop Hypertension
Tables were adapted from the listed references.
Follow-up visit of a patient in the nursing home or other outpatient setting.
Determine initial appropriate treatment option for an elderly hypertensive patient with medical co-morbidities.
60% of Americans > 60 years are diagnosed with hypertension (SBP > 140/90), but only 27% have their blood pressure controlled to the ideal range with medication. Meta-analysis data has shown that treating hypertension is imperative for preventing strokes and cardiovascular events.
Science Principles
Identify blood pressure goals in patients >65 years old. 2.List four JNC7 considerations for treatment of hypertension. 3.List four medications and the specific conditions for which they are indicated, based on patient co-morbidities. 4.List four practical lifestyle recommendations for the management of hypertension.
Review of Systems (ROS)
Geriatric Topics
ACGME Compentencies
Science Principles
Bechett, N. S., Peters, R., Fletcher, A. E., et al. Treatment of hypertension in patients 80 years
of age or older. NEJM. 2008 May 1; 358: 1887-1898.
Chobanian, A.V., Bakris, G.L., Black, H.R., et al. The Seventh Report of the Joint National
Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 Report. JAMA. 2003 May 21; 289(17): 2560-2572.
Dickerson, L. M and Gibson, M. V. Management of hypertension in older persons. Am Fam
Physician. 2005 Feb 1; 71(3):469-476.
Users are free to download and distribute Geriatric Fast Facts for informational, educational, and research purposes only. Citation: Yana Thaker, Suzanne Gehl MD, Kathyrn Denson MD, Bambi Wessel, Fast Fact #013: Hypertension in the Elderly, February, 2012.
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