Management of hypertension in the elderly patient

Gordon Stewart Stokes1,21Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; 2Department of Cardiology, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaAbstract: Hypertension in the elderly is associated with increased occurrence rates of sodium se...

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Autor principal: Gordon Stewart Stokes
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Lenguaje:EN
Publicado: Dove Medical Press 2009
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spelling oai:doaj.org-article:d48f6bb74b00416a8da307ed0c2c3dff2021-12-02T08:27:14ZManagement of hypertension in the elderly patient1178-1998https://doaj.org/article/d48f6bb74b00416a8da307ed0c2c3dff2009-09-01T00:00:00Zhttps://www.dovepress.com/management-of-hypertension-in-the-elderly-patient-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Gordon Stewart Stokes1,21Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; 2Department of Cardiology, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaAbstract: Hypertension in the elderly is associated with increased occurrence rates of sodium sensitivity, isolated systolic hypertension, and ‘white coat effect’. Arterial stiffness and endothelial dysfunction also increase with age. These factors should be considered in selecting antihypertensive therapy. The prime objective of this therapy is to prevent stroke. The findings of controlled trials show that there should be no cut-off age for treatment. A holistic program for controlling cardiovascular risks should be fully discussed with the patient, including evaluation to exclude underlying causes of secondary hypertension, and implementation of lifestyle measures. The choice of antihypertensive drug therapy is influenced by concomitant disease and previous medication history, but will typically include a thiazide diuretic as the first-line agent; to this will be added an angiotensin inhibitor and/or a calcium channel blocker. Beta blockers are not generally recommended, in part because they do not combat the effects of increased arterial stiffness. The hypertension–hypotension syndrome requires case-specific management. Drug-resistant hypertension is important to differentiate from faulty compliance with medication. Patients resistant to third-line drug therapy may benefit from treatment with extended-release isosorbide mononitrate. A trial of spironolactone may also be worthwhile.Keywords: hypertension, elderly, antihypertensive treatment, patient managementGordon Stewart StokesDove Medical PressarticleHypertensionElderlyAntihypertensive treatmentPatient managementGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 4, Pp 379-389 (2009)
institution DOAJ
collection DOAJ
language EN
topic Hypertension
Elderly
Antihypertensive treatment
Patient management
Geriatrics
RC952-954.6
spellingShingle Hypertension
Elderly
Antihypertensive treatment
Patient management
Geriatrics
RC952-954.6
Gordon Stewart Stokes
Management of hypertension in the elderly patient
description Gordon Stewart Stokes1,21Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; 2Department of Cardiology, Royal North Shore Hospital, St. Leonards, New South Wales, AustraliaAbstract: Hypertension in the elderly is associated with increased occurrence rates of sodium sensitivity, isolated systolic hypertension, and ‘white coat effect’. Arterial stiffness and endothelial dysfunction also increase with age. These factors should be considered in selecting antihypertensive therapy. The prime objective of this therapy is to prevent stroke. The findings of controlled trials show that there should be no cut-off age for treatment. A holistic program for controlling cardiovascular risks should be fully discussed with the patient, including evaluation to exclude underlying causes of secondary hypertension, and implementation of lifestyle measures. The choice of antihypertensive drug therapy is influenced by concomitant disease and previous medication history, but will typically include a thiazide diuretic as the first-line agent; to this will be added an angiotensin inhibitor and/or a calcium channel blocker. Beta blockers are not generally recommended, in part because they do not combat the effects of increased arterial stiffness. The hypertension–hypotension syndrome requires case-specific management. Drug-resistant hypertension is important to differentiate from faulty compliance with medication. Patients resistant to third-line drug therapy may benefit from treatment with extended-release isosorbide mononitrate. A trial of spironolactone may also be worthwhile.Keywords: hypertension, elderly, antihypertensive treatment, patient management
format article
author Gordon Stewart Stokes
author_facet Gordon Stewart Stokes
author_sort Gordon Stewart Stokes
title Management of hypertension in the elderly patient
title_short Management of hypertension in the elderly patient
title_full Management of hypertension in the elderly patient
title_fullStr Management of hypertension in the elderly patient
title_full_unstemmed Management of hypertension in the elderly patient
title_sort management of hypertension in the elderly patient
publisher Dove Medical Press
publishDate 2009
url https://doaj.org/article/d48f6bb74b00416a8da307ed0c2c3dff
work_keys_str_mv AT gordonstewartstokes managementofhypertensionintheelderlypatient
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