Heart Health

Hypertension in the Elderly


Christopher Ndubuka-Irobunda, MD, PhD

New York Presbyterian Hospital - Columbia Presbyterian Medical Center

Medically Reviewed On: October 27, 2013

Hypertension (high blood pressure) is a very common condition in older Americans. It is estimated that about 65 percent of people older than the age of 65 (the elderly) have hypertension. This condition carries a very high risk for stroke and heart diseases. Although many studies have shown that controlling hypertension prevents complications like stroke, heart attack, heart and kidney failure, many elderly people continue to live with uncontrolled or inadequately controlled hypertension.

How is Hypertension in the Elderly Different from the General Population's?
There are at least two types of hypertension seen in this group. Classic essential hypertension is when both the systolic (top number) and the diastolic (bottom number) of a blood pressure (BP) reading are above the normal range (usually less than 140/90). Isolated systolic hypertension (ISH) is where only the top number is high while the lower number is normal (that is, upper number greater than 140 and lower number less than 90). The diagnosis of essential hypertension is made after an initial blood pressure of greater than or equal to 140/90 is repeated and confirmed over a period of two or more weeks. ISH is diagnosed when repeated measurements show the systolic BP is greater than 140, while the diastolic is less than 90.

In general, hypertension in the elderly increases the risk for stroke, heart attack, heart failure, kidney failure, and death. However, ISH is more common, more progressive, and associated with increased risk for these complications in the elderly more than regular hypertension.

Causes of Hypertension in the Elderly
Increasing age is associated with changes in the structure of walls of the blood vessels that make them less likely to give. These changes produce loss of vascular compliance, and it affects the size and volume of the lining of the arteries and ultimately results in hypertension. These biologic changes in the arterial caliber (diameter of the blood vessels) translate into overall cardiac dysfunction and to heart failure.

Treatment Considerations
We treat hypertension in the elderly to reduce the risks associated with it. Proper treatment will reduce death and disability from this disease. I usually consider two approaches in planning to treat hypertension in my elderly patients, lifestyle modification (exercise, diet, and smoking cessation), and drug therapy.

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