Hypertension In The Elderly - To Treat Or Not To Treat

Abstract

High blood pressure is an inevitable consequence of advancing age. When the office blood pressure (BP) is >140/90mmHg HYPERTENSION is generally diagnosed. As age advances, hypertension is more difficult to evaluate and treat. In hypertensive population, up to the age of 50-60 years both systolic and diastolic pressure rises. After that the diastolic BP gradually falls, but the systolic pressure continues to rise. Thus we get the peculiar problem of Isolated Systolic Hypertension (ISH) which is defined as SBP >140mmg Hg (in the very elderly people above 80yrs it is above 160mmHg) and DBP may be 90mmhg or lower. The overall prevalence of hypertension is 30-40% (age standardized) but in those above 80 years it may be seen in up to 80% of the population. In a person aged 55-60yrs risk of life time hypertension is >90%. Systolic BP (SBP) depends on both left ventricular performance and stiffness of aorta and large arteries and diastolic blood pressure (DBP) is determined by peripheral resistance, visco-elastic properties of arteries and diastolic duration. Change in these properties of arteries, increasing stiffness along with various metabolic abnormalities and endothelial dysfunction may cause impaired blood pressure homeostasis and variability of BP which may cause orthostatic hypotension. Associated neurological problems which not uncommonly affect elderly people, dehydration, poor nutrition and iatrogenic effects of various drugs compound the problem. All these worsen the situation and frequent fall is a serious consequence of untreated as well as treated cases of hypertension.