WHO statistics show that over 1.3 billion people suffer from hypertension, with the majority being elderly individuals. If not detected and appropriately managed early, hypertension in the elderly can lead to complications and even pose life-threatening risks. So, what are the typical blood pressure levels in the elderly, and how can it be detected and treated? This article aims to address all these questions.
What is considered high blood pressure in the elderly, and what are the underlying mechanisms?
Blood pressure refers to the force of blood flow from the heart to the tissues through the arteries. The contraction of the heart muscles and the resistance of the arteries are the two main factors determining blood pressure. An elderly person is considered to have hypertension when their systolic blood pressure (SBP) is above 140mmHg and their diastolic blood pressure (DBP) is above 90mmHg.
The mechanisms behind elevated blood pressure in the elderly can be classified into two categories: primary (essential) and secondary hypertension. The specific details are as follows
Modern medicine has identified four primary factors that cause hypertension in the elderly:
- Nervous system: Increased activity of the sympathetic nervous system leads to stronger heart contractions, resulting in increased cardiac output. Peripheral resistance caused by constricted peripheral and renal arteries also contributes to elevated blood pressure.
- Serum sodium concentration: The presence of salt in the serum stimulates the release of Renin – an enzyme that maintains glomerular pressure in the kidneys and regulates blood pressure in the body. Renin also catalyzes the conversion of Angiotensin to Angiotensin II – a substance that stimulates the adrenal cortex to retain salt and water, increasing circulating fluid volume and arterial pressure.
- Body’s sodium absorption: The amount of salt absorbed by the body increases glomerular filtration capacity and water absorption, leading to increased blood volume and arterial pressure. Through cell membrane permeability, salt increases vascular tone, peripheral resistance, and blood pressure.
- Prostaglandin E2 and Kallikrein in the kidneys: Prostaglandin E2 and Kallikrein play a role in vasodilation and blood pressure regulation. Damage or impaired function of the kidneys can lead to a deficiency of Prostaglandin E2 and Kallikrein, resulting in increased blood pressure.
Compared to primary hypertension, secondary hypertension is less common and can be attributed to specific identifiable causes. Statistics show that only about 5% of hypertension patients have secondary hypertension, including:
- Atherosclerosis leading to increased peripheral resistance.
- Renin secretion due to hypoperfusion in the kidneys.
- Endocrine-related disorders: Cushing’s syndrome, Conn’s syndrome, adrenal gland tumors.
Causes of Hypertension in Older Adults
In reality, more than 90% of hypertension patients cannot determine the exact cause. Some cases of hypertension in older adults may be due to the effects of alcohol, endocrine disorders, kidney disease, and other factors.
Additionally, hypertension in older adults is believed to be related to the following issues:
- Family history: High blood pressure often has a hereditary component. If a person has parents, siblings, or other close relatives with hypertension, they are at a higher risk of developing high blood pressure.
- Gender: Older men tend to have a higher prevalence of hypertension compared to older women of the same age. However, postmenopausal women also have an increased risk of developing hypertension compared to younger women.
- Overweight or obesity: Older adults who are overweight or obese, with weight exceeding the ideal range for their height, are at a higher risk of developing hypertension.
- Diabetes: Hypertension is commonly observed in individuals with diabetes, and the coexistence of these conditions can adversely affect the heart and kidneys.
- Lack of physical activity: Insufficient physical activity and lack of participation in sports and exercise increase the risk of overweight and obesity in older adults, contributing to hypertension.
Symptoms of High Blood Pressure in Older Adults
Typically, the symptoms of high blood pressure in older adults are not very clear. Many older adults may have been living with hypertension for years without realizing it until they undergo a medical check-up or experience complications.
The symptoms of high blood pressure can vary depending on the individual’s health status and constitution. Among the most common typical symptoms are:
- Blurred vision, dizziness, and ringing in the ears accompanied by headaches.
- Prolonged fatigue and difficulty sleeping.
- Shortness of breath, flushed face, palpitations, and chest discomfort.
- Nausea and vomiting.
These symptoms may recur or appear regularly in cycles, leading to fatigue in affected individuals.
How Dangerous is High Blood Pressure in Older Adults?
High blood pressure is likened to a “silent killer” for older adults. Due to its subtle nature and difficulty in detection, hypertension often leads to extremely dangerous complications, especially in older individuals with weakened immune systems, frequent fatigue, and underlying health conditions.
High blood pressure in older adults always carries the risk of severe complications, even posing a threat to life if not detected and intervened early. The potential risks associated with this condition include:
- Heart failure: High blood pressure forces the heart to contract more forcefully than normal to quickly pump blood to target organs. This strain on the heart can lead to heart failure over time.
- Coronary artery damage: Prolonged pressure on the arterial walls makes them fragile and susceptible to damage. Therefore, high blood pressure is a significant factor in causing atherosclerosis or hardened arteries in older individuals.
- Stroke: Stroke is the most serious complication of high blood pressure, capable of claiming the life of an older adult or causing partial or full-body paralysis. This occurs when the arterial walls, under high pressure, rupture, leading to a stroke or cerebral hemorrhage.
What Should Older Adults with High Blood Pressure Do?
To treat high blood pressure in older adults, a combination of medication and monitoring of blood pressure levels is essential to maintain it at an ideal level. Here are some measures that older individuals should take to stabilize their blood pressure:
Lifestyle and Activity Changes
Early detection of high blood pressure in older adults can be effectively managed through a healthy lifestyle and appropriate daily routines:
- Engage in regular physical activity and exercise suitable for their health to maintain good well-being and strengthen immunity.
- Get enough sleep, around 8 hours per day, to promote better health for older adults and minimize disruptions in their sleep patterns.
- Adopt a balanced diet, including plenty of vegetables and increased dietary fiber in meals, while reducing daily sodium intake.
- Manage body weight effectively as obesity is a primary factor contributing to high blood pressure in older adults.
- Avoid alcohol, caffeinated beverages, and tobacco products, as they are leading factors that cause elevated blood pressure and pose serious complications.
A patient is considered to be experiencing a high blood pressure crisis when systolic blood pressure (HATT) is above 180mmHg and diastolic blood pressure (HATTr) is above 120mmHg. This is a particularly severe condition in older adults with high blood pressure, carrying numerous risks of dangerous complications that can threaten the patient’s life.
In such cases, immediate emergency hospitalization is necessary, and urgent blood pressure-lowering medications like Clevidipine, Fenoldopam, or Nicardipine, along with oxygen therapy, should be administered. Additionally, blood pressure should be gradually adjusted in older adults with high blood pressure and should not be rapidly normalized.
Using Medication to Treat High Blood Pressure
For more severe cases with potential complications, a combination of proper lifestyle and medication is necessary to treat high blood pressure in older adults. Depending on each case, doctors will prescribe corresponding medications for the patients:
- Diuretics: These medications help reduce blood volume by increasing fluid excretion. Typically, older adults respond well to diuretics compared to younger patients.
- Vasodilators: These drugs increase the dilation of blood vessels, thus reducing blood pressure and improving its effectiveness.
- ACE Inhibitors: They inhibit the conversion of Angiotensin into Angiotensin II, helping the kidneys reduce salt and water retention, thereby lowering blood volume and effectively reducing blood pressure.
- Beta-Blockers: These medications decrease the intensity of heart muscle contractions, leading to lower blood pressure and heart rate.
Monitoring Blood Pressure at Home, Regular Check-ups
If there is an older adult in the family, actively monitoring blood pressure at home using a blood pressure monitor is essential. This not only ensures proper blood pressure control but also helps prevent dangerous complications. It is especially crucial to monitor blood pressure during and after high blood pressure episodes.
Older patients with high blood pressure should undergo regular check-ups at least every 6 months. This will help maintain good blood pressure control and promptly detect potential complications for timely intervention.
Preventing High Blood Pressure in Older Adults
To improve the quality of life and maintain longevity, maintaining balanced blood pressure in older adults is crucial, especially for high-risk individuals. Here are effective ways to prevent high blood pressure in older adults:
- Regularly self-monitor blood pressure at home and take timely action if abnormal readings are detected.
- Undergo health check-ups every 6 months to assess overall health, prevent high blood pressure, and monitor age-related conditions.
- Adopt a low-sodium diet and control salt intake in each meal.
- Ensure a well-balanced diet, consume plenty of fruits and vegetables, and limit processed and canned foods.
- Manage weight and engage in physical activities to boost immunity and overall health.
- Quit smoking, alcohol, and stimulants. These not only harm health but also pose a risk for high blood pressure.
High blood pressure in older adults always carries inherent risks, directly threatening health and life. Therefore, be proactive in monitoring body signals and intervene promptly if any abnormalities arise. Avoid letting the disease progress to severe complications due to subjective complacency.
John Alen was born in 1971 and is a doctor in the healthcare and psychology fields with many years of experience. He is currently working at easyhealthylive.com, a leading health and psychology blog. Having studied at Y1 National Medical University named after IM Sechenov, John Alen is using his knowledge and experience to help improve the physical and mental health of people in the United States.