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Hypertension in Elderly Population 291

Bell of the stethoscope should be lightly applied over Evaluation:
the brachial artery for auscultation because Korot- FBS,PPBS, lipid profile, complete blood count, uri-
koff sounds are low pitched (9). BP measurements nalysis with microscopic examination, and electro-
are recorded to the nearest 2 mmHg. Three measure- cardiogram are reasonable for an initial evaluation.
ments should be done and average of the last two
measurements should be taken as the value for that Treatment Issues in Elderly
visit. Three visits with six measurements should be
taken to diagnose systemic hypertension . - Antihypertensive drugs are strongly advocated in
elderly , though most datas are on patients with
White coat hypertension is more commonly seen in age < 80 yrs .
elderly –Home monitoring and ABPM have got ad-
vantage in this population. Ambulatory (24 hour) BP - HYVET trial demonstrated clear benefit if used
monitoring can detect dipper, non-dipper, early morn- above age > 80 yrs of age.
ing surge pattern-which is associated with severe CV
events. Goal to be achieved :
Below 80 yr target BP 140/80 is desirable , but above
Clinical Issues 80 yr, SBP 140-45 is desirable.
• White Coat Hypertension In elderly BP lowering below 130/ 70 mm Hg not de-
• Labile Hypertension sirable due to increased incidence of orthostatic fall.

• Pseudo hypertension As per JNC 8,
• Postural hypotension “In the general population aged 60 years or older,
initiate pharmacologic treatment to lower BP at sys-
• Secondary Hypertension tolic blood pressure (SBP) of 150 mm Hg or higher or
• Resistant hypertension diastolic blood pressure (DBP) of 90 mm Hg or higher
and treat to a goal SBP lower than 150 mm Hg and
• Polypharmacy and drug interaction goal DBP lower than 90 mm Hg.
• Nonadherence (Recommendation : grade A)
Measuring only office BP may give erroneous result In the general population aged 60 years or older, if
in BP due to white coat hypertension.For that pur- pharmacologic treatment for high BP results in low-
pose,24 Hrs ABPM should be considered. There is er achieved SBP (for example, <140 mm Hg) and
Fluctuation in BP from day to day, hour to hour due to treatment is not associated with adverse effects on
arterial stiffness and decreased windkessel effect of health or quality of life, treatment does not need to
aorta. Higher prevalence of Atherosclerosis gives rise be adjusted.
to a substantial portion of patients with pseudo-hy-
pertension. Loss of autonomic tones, baroreceptor (Recommendation: grade E)”
sensitivity gives rise to postural hypotension and
post prandial hyotension. After a high-carbohydrate Treatment issues:
meal, supine BP declines, and heart rate increases
without an increase in plasma norepinephrine levels . Non Pharmacological treatment:
Lifestyle changes particularly weight loss, avoidance
Secondary hypertension should be suspected if there
is sudden surge of SBP and DBP, particularly DBP, of sedentary lifestyle, reduced sodium intake are
occurrence of Malignant hypertension, presence of beneficial in controlling BP in elderly hypertensive.
resistant hypertension.Common secondary causes of However these changes have to be in moderation, as
hypertension are chronic kidney disease, reno-vas- they should not compromise with the quality-of-life
cular hypertension, Obstructive Sleep Apnoea, Hy- in the elderly as IHD, cardiac failure, renal failure,
pothyroidism. Resistant Hypertension is seen due to peripheral vascular disease and orthopedic problems
arterial stiffness, Higher baseline BP , Co-morbidities, are also co-existent in this population.
increase salt intake, sedentary lifestyle, nicotine, al-
cohol intake,Poor compliance, Volume overload, Pharmacological Treatment:
NSAID use. What guidelines say
As per ACC/AHA 2011 ,

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