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290 Cardio Diabetes Medicine 2017

Hypertension in Elderly Population

Prof. Dr. Jyotirmoy Pal,

Professor, Dept of Medicine, RG Kar Medical College
Subhadeep Gupta, Amlan Kusum Datta, Manidipa Majumdar
Post Graduate Trainee, Dept of Medicine, RG Kar Medical College

Introduction: Consequences of decreased vascular compliance
Hypertension is a very important public health prob- are Relative increase in systolic pressure, Increase
lem all over the world. It follows iceberg pattern where in pulse pressure (SBP – DBP),Decreased Diastolic
unknown number of cases far exceeds known cas- blood pressure, Lower intravascular volume . De-
es. Hypertension is a threat to life at all ages and in creased Baroreceptor Sensitivity results in Increased
both sexes. Prevalence of hypertension is increasing BP variability, Impaired BP homeostasis with Early
alarmingly in developing countries and is now one of morning BP surge, Postural (orthostatic) hypoten-
the leading causes of morbidity and mortality among sion, Post-prandial hypotension, Orthostatic Hyper-
the elderly. Prevalence of hypertension in India in the tension. Two thirds of older hypertensives are sodium
last three decades has increased manifold, approx- sensitive. This is because decreased GFR, increased
imately by about 30 times among urban residents proximal tubular reabsorption, decreased produc-
whereas about 10 times among rural residents. Av- tion of natriuretic factors. Neurohumoral Changes
erage life span all over the globe has been increas- are in form of Decreased Beta receptor sensitivity,
ing. In the year of 1961, Indian elderly were 5.63%, Increased Nor-epinephrine , Increased Renin activity,
numbering around 24.7 million whereas in 2001, it Increased Aldosterone activity.
has risen to 7.4%(76.6 million). By considering cur-
rent demographic trend it is projected that in middle BP Measurement:
of this century geriatric population will go up to 324 For measuring blood pressure, patient should have
million i.e. four times of the current aged population. taken rest for 5 minutes and he should not have
Increase in hypertension prevalence in elderly is due taken caffeine or tobacco in last 30 minutes .Patient
to changes in arterial structure and function accom- should be made to seat with support behind his
panying aging process. Subjects with uncontrolled back and legs should remain uncrossed with arm at
or poorly controlled hypertension are known to have heart level. The use of android sphygmomanometer
higher risk of developing coronary artery disease is now-a-days recommended by WHO.
(CAD), congestive heart failure, Cerebro Vascular dis- Radial artery should be palpated during initial cuff
ease and stroke. The elderly population in India is inflation which help in determining the level of sys-
second largest in the world. According to 2011 censes tolic BP and rules out presence of auscultatory gap
8.1% are of the age 60 years and above.
which if not done, can underestimate SBP or overes-
timate DBP. Auscultatory gap is commomly seen in
Physiological changes in Old Age: elderly, female sex, increased arterial stiffness, and
• Decreased vascular compliance atherosclerosis.
• Decreased baro receptor sensitivity If the pulse less radial or brachial artery can be pal-

• Increased Salt-sensitivity of blood pressure pated after occlusion by the cuff, pseudo hyperten-
sion should be suspected. Lack of understanding of
• Increased total and central adiposity this entity can falsely over- diagnose hypertension
• Neuro-humoral Changes in aging and injudicious use of anti hypertensive drugs.

GCDC 2017