High blood pressure (hypertension) is a condition characterized by having high force of the blood against the arteries’ walls. The American Heart Association (AHA) defines hypertension as blood pressures higher than 130 over 80 mmHg (Whelton et al., 2018). Normal blood pressure is 120 over 80mmHg. Arterial pressure is determined by cardiac output and peripheral resistance (Guzik & Touyz, 2017).

 

Hypertension can be categorized into two main types: essential hypertension and secondary hypertension. The latter implies that there is an underlying condition causing high blood pressure such as chronic renal disease, aortic narrowing or endocrine conditions such as Cushing’s disease. Several factors play an important role in the pathogenesis of this condition and include: genetics and activation of the neurohormonal systems such as the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) mechanism. Patients with hypertension may have elevated cardiac output or an increase in peripheral resistance or both. However, in older adults with hypertension, the main cause is usually increased peripheral resistance. The thickness and elasticity of the arteries wall increase and decrease with age respectively. A reduction in the elasticity of the arteries’ wall results in increased vascular resistance thus hypertension occurs (Guzik & Touyz, 2017).

 

Patients with hypertension usually present with headaches, confusion, blurred vision, chest pain, and difficulty in breathing, an irregular heartbeat and a drubbing sensation in the chest or neck. It is crucial to screen for and manage other cardiovascular risk factors in hypertensive patients such as smoking, diabetes, obesity, poor diet and psychosocial stress. Basic testing include: fasting blood glucose, lipids, basic metabolic profile, thyroid-stimulating hormone (TSH) levels and urinalysis.

 

The first-line therapy for hypertension stage I includes comprises of thiazide diuretics, calcium channel blockers (CCBs), angiotensinogen converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) (Whelton et al., 2018). Chlorthalidone is the preferred diuretic due to its long half-life and CVD risk reduction (Whelton et al., 2018). ACEIs, ARBs and direct renin inhibitors should not be used in combination. Spironolactone is preferred for the management of primary aldosteronism and in resistant hypertension (Whelton et al., 2018).

 

Non-pharmacologic management of hypertension includes: weight loss for obese patients, restriction of salt intake, potassium supplementation in diet and increased exercise with a defined physical activity plan. Hypertension in older adults can result in severe medical complications. Cerebrovascular accidents might occur due to hypertension leading to ischemic stroke and cerebral hemorrhage. Furthermore, the risk of Alzheimer’s disease is also increased in these patients. Older adults with hypertension also have an increased risk of myocardial infarction as well as increasing the risk of retinal artery occlusion.

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Hypertension is a grave public health concern in America and affects about 30% of adults. Approximately 1000 deaths occur daily due to hypertension. The prevalence of hypertension in America is 28% compared to 44% in Europe. Furthermore, the prevalence is higher in African Americans than in the Caucasian Americans (Yoon, Fryar & Carroll, 2015).

 

Patients with type 2 diabetes mellitus are twice more likely to suffer from hypertension compared to the general population. Hypertension affects 20-40% of the adult population in America, meaning that about 250 million individuals suffer from hypertension in America. Higher prevalence rates of hypertension are linked to aging, behavioral risk factors such as sedentary lifestyle, obesity, cigarette smoking, excessive alcohol drinking and stress.

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Hypertension affects all the aspects of life of older adults who have the disease. The prevalence of hypertension is high in older individuals who lack awareness about the aforementioned condition. Hypertension negatively impacts one’s daily activities and it is important that hypertensive patients be knowledgeable about the disease in order to understand how it presents as well as how to effectively manage the disease. Besides, it is also crucial for older adults with hypertension be knowledgeable of the drugs used in the management of hypertension. This will be achieved by health care professionals providing education to the patients as well as making them aware of the side effects associated with these drugs.

 

The Healthy People 2020 is crucial in creating awareness amongst the public as it advocates for hypertension screening for those who are at risk (Yoon et al., 2015) with the elderly in society being one of the groups at risk. It is also important to understand that an unhealthy lifestyle characterized by lack of regular physical activity and poor eating habits interferes with the management of hypertension. Having access to information about hypertension promotes patients’ knowledge and attitude concerning the disease.

 

Older adults with hypertension should also understand that restricting salt intake in their diet is good for their health. Besides, they should understand the perceived benefits of being aware of the disease as well as its effective management.

Older adults with hypertension should comprehend the importance of treatment compliance in order to effectively manage the chronic condition. Adherence to treatment ensures that their blood pressures are controlled and fall within the normal ranges.

 

Health care professionals should emphasize the importance of treatment compliance to older adults with hypertension. Being aware of the side effects of these drugs will also be crucial in promoting treatment compliance. Social support provided to patients is also important in ensuring that the patients comply with the pharmacologic therapy for hypertension (Lo, Chau, Woo, Thompson & Choi, 2016). Furthermore, attending clinic appointments regularly is directly linked to sustaining treatment compliance and it is important that older adults with hypertension believe that it is necessary to take antihypertensive medication even when they are not feeling sick (Lo et al., 2016).

 

Additionally, patients who understand the disease and its complications will strive to ensure that they comply with the medication. In order to effectively manage hypertension, patients should be knowledgeable about the disease as well as how their lifestyle has a huge impact on the disease. One recommendation would be to limit salt intake in their diet since this has a role in the regulation of blood pressure. Furthermore, their treatment should target achieving a systolic blood pressure of less than 150mmHg. Effective management of hypertension decreases the risk for cardiovascular disease, renal disease, cerebrovascular accidents such as ischemic stroke and also death. Lifestyle modification is another recommendation that would be effective in the management of hypertension. Older adults living with hypertension should understand their attitudes and beliefs have an impact on hypertension management.

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J.M. is a 60 year old living with hypertension for the past 5 years. The patient lives alone and has two sons who are very supportive. She actively interacts with her friends. However, she has recently been experiencing symptoms of headache, fatigue and pounding sensation. She is currently on ramipril and felodipine. She has been forgetting to take her medication. It is important that J.M’s physician educate her on the importance of treatment compliance as well as encourage her sons to ensure that their mother takes her medication. Furthermore, the patient should also be educated on the disease and its complications.

 

References

Guzik, T. J., & Touyz, R. M. (2017). Vascular pathophysiology of hypertension. The ESC Textbook of Vascular Biology, 291.

Lo, S. H., Chau, J. P., Woo, J., Thompson, D. R., & Choi, K. C. (2016). Adherence to antihypertensive medication in older adults with hypertension. The Journal of cardiovascular nursing, 31(4), 296.

 

Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., ... & MacLaughlin, E. J. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.

Yoon, S. S., Fryar, C. D., & Carroll, M. D. (2015). Hypertension prevalence and control among adults: United States, 2011-2014. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.