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Hypertension is a Primary Cause of Death in Older Adults

There are many health issues that affect the older adult population in the United States. Cardiovascular diseases are the primary causes of death among the elderly—especially, hypertension. Hypertension is essentially high blood pressure and it is currently one of the most important public health problems in developed countries. Not only is it extremely common, normotensive people at age 55 have a 90% lifetime risk of hypertension. There are many effective treatment options. However, if an older adult with hypertension is left untreated, this can significantly increase the risk of cardiovascular events such as strokes and ischemic heart disease.

Normal blood pressure is less than 120 systolic over 80 diastolic. Hypertension can be defined as over 140 systolic and 90 diastolic, but elevation in only one measure is sufficient for the diagnosis. Pre-hypertension is either 120-139 systolic or 80-89 diastolic, or both. Current trends are attempting to redefine normal blood pressure as lower than 115 over 75 and define pre-hypertension as an early stage of disease. This is due to the fact that those with pre-hypertension have a 3.5 times higher risk of myocardial infarcation and 1.7 times higher risk of coronary artery disease.

There are two general types of hypertension that older adults can develop. The most common is primary hypertension, also known as essential hypertension. An estimated 95% of all cases are those with primary hypertension. It is interesting to note that the biological etiology of this type of hypertension is unknown—there are multiple physiological changes that can contribute to this elevation in blood pressure. The other type of hypertension is secondary hypertension, which is a direct consequence of another disease, the most common causes being disorders of the kidneys and adrenal gland.

The pathological consequences of hypertension are numerous. High blood pressure can cause cardiac hypertrophy, in which the left ventricle of the heart becomes enlarged due to cardiac compensation. This enlargement of the left ventricle can directly cause sudden death, stroke, heart failure, or ventricular dysrhythmias.

Hypertension can also lead to hypertensive nephropathy, in which cartilage accumulates in the arterioles of the kidney and results in blockages that reduce blood supply to the heart. This can result in progressively impaired renal functioning, which is responsible for approximately 10% of hypertension-related deaths.

Chronic hypertension can also cause retinal changes in the eyes, called hypertensive retinopathy. The arterioles of the retina narrow and can even hemorrhage, resulting in blurred vision and sometimes blindness. The condition can also lead to changes in the central nervous system, often causing a patient to have headaches, dizziness, tinnitus, and even vascular dementia.

Although many elderly patients have hypertension, there are multiple treatment options that can significantly decrease the risk of mortality. Older adult residents in nursing homes and assisted living facilities who need treatment for hypertension can benefit from appropriate changes in diet and engagement in aerobic exercise. There are also drug therapies that can treat hypertension such as the use of diuretics, anti-adrenergics, vasodilators, calcium channel blockers, and ACE inhibitors. Drug therapies for senior long-term care facility residents with hypertension should be given with utmost care and precaution.