February 04, 2012
   
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Hypertension in the Elderly: Too Little, Too Late
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Hypertension in the Elderly: Too Little, Too Late

Abbas Ali, M.D.
 
Dr. Ali is a Fellow, Geriatrics Division, Saint Louis University School of Medicine, St. Louis, MO. Dr. Ali reports no conflict of interest.


Hypertension (high blood pressure) is a deadly disease that is especially common in the elderly. Over time, abnormally high blood pressure damages the heart and kidneys and increases the risk of stroke, aneurysm and heart attack. Virtually symptomless, hypertension often goes untreated or undertreated. What do doctors know about it and what can be done to treat high blood pressure?

Doctors do know that hypertension becomes more common with age; over 50% of those over 65 have it. In the elderly, hypertension typically takes the form of high systolic blood pressure (SBP), low diastolic blood pressure (DBP) and orthostatic hypotension. Blood pressure readings are expressed by two numbers separated by a slash, e.g., 120/80. The first number is the systolic blood pressure and the second is the diastolic; orthostatic hypotension is an excessive drop in blood pressure when a person stands up; this causes fainting and dizziness.(1)

While all of these conditions are fairly treatable, the reality is that treatment of hypertension in the elderly today leaves much to be desired.(2)(3) Any older person making health care decisions or anyone who is caring for an older person should educate themselves about hypertension, and raise the issue with their doctor or other health care professional.(4)

The Right Way to Take Blood Pressure
Diagnosing hypertension starts with measuring the blood pressure. Taking blood pressure is a simple thing, but it is often done incorrectly. First of all, it is important that the sphygmomanometer, the familiar instrument with a black rubber cuff that is used to take blood pressure, be the right size. Cuffs that are too small for a particular person's arm may give falsely high readings.(5)

Smoking two cigarettes will temporarily raise BP by 10/8 mm Hg for 15 minutes. Drinking a cup of coffee will elevate BP by up to 10/7 mm Hg for from one to two hours.

Second, someone who is about to have their blood pressure taken should avoid food, exercise, caffeine and smoking one hour before BP measurement.6 Smoking two cigarettes will temporarily raise BP by 10/8 mm Hg for 15 minutes. Drinking a cup of coffee will elevate BP by up to 10/7 mm Hg for from one to two hours.(7) The patient should sit in a warm room for at least five minutes with their arm supported at the level of the heart. Letting the arm hang will elevate SBP by 10 mm Hg because of the effects of gravity.(8)(9)

Finally, BP should be checked in both arms; the arm with the higher reading should be used for later readings.(10)

What's Pseudohypertension?
Pseudohypertension is the appearance of high blood pressure in someone who, in fact, does not have it. One common cause of false high blood pressure readings occurs because compression of the brachial artery in the arm, which is common in the elderly, requires using a higher cuff pressure when taking blood pressure. This will produce systolic and diastolic pressure readings that are 10 mm Hg too high or higher.(11)

The Major Risk Factors for Hypertension
Medical researchers have identified factors that increase your risk of having high blood pressure:
  1. High salt diet — the relation between hypertension, diet and salt intake was demonstrated by a famous study called the DASH low sodium trial. Reduction of salt intake combined with a dietary regimen called DASH (Dietary Approaches to Stop Hypertension) successfully helped many to lower their blood pressure.(12)
  2. High alcohol intake(13)
  3. Family history of hypertension
  4. Obesity — the risk of hypertension for moderately obese men is two times higher than men who are not obese.(14)
  5. African-American heritage — hypertension is more common and more severe in African-Americans than in otherAmericans.(15)
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