Hypertension in the Frail Elderly Literature Review
Hypertension in the frail elderly is a healthcare issue that requires urgent attention. Increased blood pressure is prevalent among the elderly and can result in other complications such as cardiovascular risk and an increased mortality rate. Yet hypertension can still develop in patients without a history of blood pressure. Some of the factors that increase older persons’ risk of contracting hypertension include weakening of the renal and baroreceptor functions, obesity, stress, poor nutrition, the rigidity of the capacitance arteries caused by aging, and a decrease in potassium intake. There is no particular age for hypertension develops – medical scientists have confirmed that individuals of all ages are at risk of hypertension. Hypertension can be identified by obtaining the values of a patient’s diastolic and systolic pressure, with the former being greater or equal to 90mmHg and the latter being greater or equal to 140mmHg (Pinto, 2007). However, the figures may slightly vary, especially for the frail elderly, whose blood pressure seems to be increasing with age. Drugs are the most common treatment for hypertension, particularly calcium blockers and thiazide.
Studies show that arterial hypertension affects a large portion of the frail elderly. According to HYVET (Hypertension in the Very Elderly Trial), reducing blood pressure among this population can minimize both morbidity and mortality rates. A study of this population group, minus the ill individuals, showed that the use of hypertensive treatment reduced blood pressure to a systolic blood pressure of less than 150/80 mmHg. Consequently, the likelihood of members of this population group succumbing to hypertension, suffering heart failure, or a fatal stroke was reduced by 21%, 64%, and 39%, respectively (Gupta & Kasliwal, 2004). A common finding in frail elderly patients is a raised systolic pressure of above 140mmHg. Hypertension increases morbidity rates and causes conditions such as peripheral artery disease, deterioration in their cognitive status, coronary artery disease, and renal failure, among others. Another study stated that the factors determining the kind of treatment to be undertaken depending on the blood pressure level. For instance, there are certain blood pressure levels that require the administration of antihypertensive drugs, while others rely on therapy. More so, the frail elderly are a fragile hypertensive population group and hence require a specific approach to be adopted.
According to Gupta & Kasliwal (2004), a patient can go for even more than ten years without any symptoms of hypertension. During this asymptomatic period, the impact of hypertension on the cardiovascular system is grave enough to damage it and cause further complications. As such, the practice of assessing a patient’s blood pressure during every hospital visit has been normalized. The results obtained are used to decide whether the patient needs treatment or not. A diastolic blood pressure of above 90 mmHg and systolic blood pressure of above 140 mmHg is a sign of high blood pressure (Ferri, Ferri, & Desideri, 2017). The occurrence of abnormal blood pressure results in the frail elderly is very common, which is why treatment is always required to prevent their weakened organs from completely failing.
For all patients, both the aged and the young, two forms of treatment are commonly used – pharmacological and nonpharmacological strategies. Nonpharmacological measures are often considered therapy. Some of these measures that have been used on the frail elderly in the past and present include nutritional sodium restriction, alcohol restriction or moderation, prescription of potassium supplements, nutritional changes and encouraging them to quit smoking. The combination of these nonpharmacological treatments has, over the years, helped relieve hypertension impacts, such as preventing the damage of the cardiovascular system. The ideal amount of sodium that should be ingested in a day is 2.4g (Buonacera, Stancanelli, & Malatino, 2018). This form of treatment has been responsive in some of the frail elderly patients. Potassium supplements are normally issued for a given period of time since a routine use can alter serum levels. Potassium supplements are efficient because they reduce blood pressure by about 3.1/2.0 mmHg. Moderation of alcohol intake is known to also lower blood pressure. Studies show that a portion of the frail elderly suffers from high blood pressure as a result of alcohol abuse. However, blood pressure caused by alcohol abuse is reversible, hence the need to moderate on its intake. With regard to nutrition, a diet consisting of lots of fruits and vegetables, and foods rich in fiber lowers blood pressure as proven in the Dietary Approaches to Stop Hypertension (DASH) trial as well as the Trial of Nonpharmacological Inventions in the Elderly (TONE) (Kario et al., 2002). Further, smoking poses a threat of developing hypertension, especially for the frail elderly whose organs are already weakened by age. Thus, quitting smoking can go a long way in preventing the damaging of the cardiovascular system.
On the other hand, pharmacological treatment entails dispensing of drugs. However, prior to the dispensation of medication, some factors such as possible drug interactions, the presence of alternative measures, possible cardiovascular risk, and the potential of organ damage. Frail elderly are prone to chronic illnesses, and therefore, the possibility of drug interactions are not to be overlooked. Similarly, researchers have repeatedly mentioned that alternative measures such as nonpharmacological measures should be considered before prescribing medicine to this population group (Musso, Jauregui, Macias-Nunez, & Covic, 2019). These alternatives should be chosen, especially when the cardiovascular system or other organs are at risk of being damaged by the prescribed medication. Conclusively, the general health of these patients – the frail elderly – should be of consideration when determining the right mode of treatment.
References
Buonacera, A., Stancanelli, B., & Malatino, L. (2018). Management of Hypertension in the Elderly: Looking for a trade-off between cardiovascular prevention and serious adverse events. Semantics scholar. Retrieved from https://pdfs.semanticscholar.org/c95e/d26e1dc0076ab4d542727d58cb2989cb4f7c.pdf
Ferri, C., Ferri, L., & Desideri, G. (2017). Management of Hypertension in the Elderly and frail Elderly. NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28181201
Gupta, R., & Kasliwal, R. (2004). Understanding Systolic Hypertension in the Elderly. Japi. Retrieved from https://www.japi.org/june2004/R-479.pdf
Kario, K., Eguchi, K., Hoshinde, Y., Umeda, Y., Mitsuhashi, T., & Shimada, K. (2002). U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor. NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12103267
Musso, C. G., Jauregui, J. R., Macias-Nunez, J. F., & Covic, A. (2019). Clinical Nephrogeriatrics. Cham, Switzerland: Springer.
Pinto, E. (2007). Blood Pressure and Ageing. NCBI. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/17308214