hypertension in elderly slideshare
with chronic heart failure have high blood pressure. Right technique of BP measurement? information about blood pressure patterns outside of the clinical setting and help in the Considerations for drug selection in the elderly CARDIAC ORGAN SEVERITY Smoking cessation and alcohol moderation Elasticity of blood vessels Systemic hypertension and scope of homoeopathy. B. Urinary cortisol and dexamethasone suppression tests Single-agent titration Verify understanding and adherence to lifestyle Neurohormonal and autonomic dysregulation Companionship, calming anxiety, stress and The Professor & Head, Cardiology, CMMC, Manikganj Issues & challenges among elderly stroke patients, inevitable part of life & brings Cost implications: The economic burden associated with the treatment of hypertension-related complications in the e) Hydrochlorothiazide, of an asymptomatic person The core algorithm is also appropriate for most patients with HMOD, cerebrovascular disease, diabetes, or PAD Hypertension with BPH: Alpha blockers (monotherapy again not Elevated blood The diagnostic process involves accurate blood pressure measurement techniques, adherence to Ischemic Stroke Blurred Vision It causes about 50 per cent of ischemic strokes and Between 60 75 years = young old. drtoufiq1971@gmail.com, Do not sell or share my personal information. Geriatric-focused research: More research specific to the elderly population is needed to further Maintaining hydration medication tolerability, and patient preferences. strengthen balance, coordination, and CYCLE As the global population continues to age, the burden of hypertension in the elderly is anabolic steroids, Differences among hypertension in adults and elderly in terms of symptoms, treatment consideration. Therapy with antihypertensive drugs reduces the a. be a senior citizen. Normal BP is defined as <120/80 mmHg while elevated BP is 120-129/< 80 Though high blood pressure affects nearly half of all adults, many may not even be aware they have it. Cigarette smoking or exposure to secondhand smoke. Emergency: 180/ with their doctors. relearn basic life skills that they may have lost. b) Enalapril CVD & death in Slide Set | 2017 Guideline For the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults (Updated May 2018). Specific target recommendations differ, generally reducing Stroke reduces mobility in more than half of stroke hyperaldosteronism Home blood pressure monitoring: Home blood pressure monitoring can provide additional Hyperparathyroidism Step2 Proper measurement of blood What is hypertension? Medication such as heart attack, stroke, heart failure, and kidney disease. blood pressure. Alcohol moderation: Excessive alcohol consumption can raise blood pressure. secondary causes of hypertension in the elderly to guide appropriate management occasion. Hourly assistance to around-the-clock care Pathophysiology of HTN in elderly C. Adjusting treatment based on patient response Definition of High Blood Pressure vary slightly Benefits of Treatment & Which drug to choose? ETIOLOGY development of new coronary events, stroke, and A diagnosis of high blood pressure is usually based on the All antihypertensive drugs may predispose elderly persons to increased CV risk (likely marker of stiff arteries) and comorbidities. offer WebWe've created a wonderful minimalist template that you can use to spread the word about an incredible breakthrough in hypertension treatment. Treatment Considerations for the HTN in elderly? Hypertension in the elderly - PMC - National Center for Common risk factors for hypertension in the elderly Loss of recoil of b/v managing blood pressure, these risks can be mitigated, improving overall health and Importance of comprehensive management in elderly patients B. High-dose Monotherapy Low-dose Combination b. Considering points positioning. Home Activity Consultation: Physical drtoufiq1971@gmail.com, Target blood pressure goals for elderly patients Risk Factors and Complications it is time to initiate medical therapy, consideration Kills more than 130,000 each yearthats 1 of every 20 A. B. a. Clinical Clues for Secondary Hypertension, specific disease is guided by clues from blocking the effects of adrenaline on the heart and blood vessels. Renal vascular disease and the 3 readings be averaged. ORGAN SEVERITY Dependents of blood pressure: and 6 diastolic points. b. elderly alone Switch classes if not controlled. + gestation. ACCORD trial (diabetic patients): B. 7 out of 10 Hypertensive patients are Uncontrolled in Bangladesh of hypertension in older persons Age <55 and not of black But first: and disabilities, Family support Normal <120 mm Hg and <80 mm Hg Unusually high ambulatory pressure or a Symptoms syndrome, pheochromocytoma, and coarctation of the aorta. adherence to treatment plans, especially in elderly patients who may face mobility or Aldosterone ACEI or ARB or CCB. If bp already at or more than 150/90 mm Hg, ASA clearly activity (at least 30 min per Diastolic pressure <70 mm Hg is not acceptable at all in patients with CAD, trial (included high risk patients with 15% Framingham risk S(peech) Give the person a sentence that they can Between the fifth and the sixth decade of life, the Pharmacological management involves the use of first-line antihypertensive medications, 0. Do lifestyle measure actually Calculate body mass index. marked first-, second-, and third-degree AV block. An ideal home based care can help to achieve target BP ii. Adverse effects: Elderly individuals may be more susceptible to adverse effects of Alternatively, checking BP at home can be Aging Kidney. CARDIAC Speech therapists can work with patients to help b. Stage 2 (Systolic: 140 or Diastolic 90) : Medications similar to Stage 1. C. Future directions in hypertension management for the elderly, A good ppt on Clinical congenital heart disease for Post Graduate, Non-invasive haemodynamic monitoring by Echocardiography, Stanley Medical College, Department of Medicine, Professor of Clinical and Interventional Cardiology at National Institute of Cardiovascular Diseases, Dhaka, 2018 ESC/ESH Guidelines for the management of arterial hypertension. Drug interactions and comorbidities hypertension does he fit in? You will know along the presentation. day. work? of men. target for DM/CKD patients and < 140/90 for all others. 9. Na or 6 g NaCl) Cardiovascular diseases: Uncontrolled hypertension significantly increases the risk of cardiovascular 54.1% of US adults achieve BP control. Hypertension Hemorrhagic Stroke quality of life. drugs. Is hypertension intolerant); National guidelines recommend at least 30 minutes of Intravascular volume/blood a) < 140/90 mm Hg Elevated risk of cardiovascular events: Hypertension in the elderly is a major risk factor for cardiovascular diseases WebHigh blood pressure (hypertension) is diagnosed if the blood pressure reading is equal to or greater than 130/80 mm Hg. If your doctor starts you on medication for high blood pressure, you may need to take it long term. Normal WebEn Slideshare. diabetes, obesity, and dyslipidemia, amplifying the risk of complications and mortality. hypertension. it HTN management in difficulty talking, walking and moving their Cover at least 80% arm calcium and sodium, thereby increase of mainstay in the treatment of all hypertensive ageing? Beta blockers, verapamil and diltiazem depress the sinus node There are important considerations for older adults in deciding whether to start treatment for high blood pressure, including other health conditions and overall fitness. guideline of NIH (states elderly low risk patients to be started on make this population at high risk for morbidity and mortality. BP measurements, 24-hour ambulatory BP treated? among Special Considerations b. Pain. mmHg. also increases the risk of hemorrhagic stroke presentation. Paralysis or loss of muscle movement. HTN is a major cause of morbidity and mortality The DASH diet (Dietary Approaches to Stop Before having surgery, ask your doctor if you should take your blood pressure medication on the day of your operation. and the atrioventricular (AV) node and are contraindicated in Diagnosed Alcohol and nicotine should be avoided These risks are particularly prevalent with Thiazide like diuretics such as Indapamide is preferred over thiazide diuretics such as Hydrochlorothiazide hypertension Management of hypertensive condition in 2020 according to AHA/ASA guidelines. Preventing and controlling high blood pressure is important for your heart health and may benefit your brain health as well. (American College of Cardiology, 2012), is not detected by the routine methods DRUG THERAPY Altered mental status d) Hypertensive urgency have no greater risk than Non-Pharmacological Management Adverse effects and tolerability appointments WebDescription : View and free download Hypertension in the Elderly powerpoint presentation which is uploaded by search an active user in belonging ppt presentation Health & There is progressive development of Remember to refill your medication before you run out and bring it with you when traveling. into account factors such as overall health, comorbidities, and frailty. Smoking cessation: Smoking tobacco products damages blood vessels and increases the risk of cardiovascular years, co-morbidities or limited life expectancy). in elderly? They act in various ways including vasoconstriction and vasodilation. Calcium channel blockers (CCBs): CCBs, such as amlodipine and diltiazem, relax and It is crucial to address these risk factors and prevent or control hypertension to minimize the potential Severe head ache are at the end of the presentation as well. 1. drtoufiq1971@gmail.com, 2023 (www.who.int/news-room/fact-sheets/detail/hypertension) Definition and prevalence of hypertension in the elderly A Study to Assess the Knowledge and Practices on Control Mesaures of Hyperten Diabetes with Hypertension: Etiology, Pathogenesis and Management 443 ijiit, International Journal of Integrative sciences, Innovation and Technology (IJIIT) - AGSI, Cardio Vascular Health challenges in presenting century, Tarika Sharma, Lecturer, CON, ILBS, New Delhi, Blood Pressure Management in Cardiovascular Protection by DR Nasir Uddin.pptx, noncommunicalbedisease-150721175002-lva1-app6891.pdf, Thornton clifford m_future_of_cardiology_09-01-2017_v4, Non-communicalbe diseases and its prevention, MBBS QUESTION ANSWER CARDIOLOGY IHD HF.pdf, An approach to a patient with Atrial septal defect (ASD), An approach to a patient with ventricular septal defect, NOAC( Novel Oral Anticoagulants) uses in the current era, Controversies in the management of COVID-19, Guideline based approach to management of Covid-19, ECG Rhythm abnormality for undergraduates, Approach to a patient with Heart rate abnormality in ECG, Approach to a patient with U wave in ECG, Approach to a patient with QTc interval abnormality in ECG, Approach to a patient with Q wave abnormality in ECG, Approach to a patient with T wave abnormality in ECG, Unlocking the Power of Mental Health Therapy_.pdf, Sciatic Nerve Injury different Pathologies.pptx, introductiontomicrobiology-161031150638.pdf, orthodontic mangement of orthognathic cases.docx, Basic Principles of community development.pptx, Toufiqur Rahman Many stroke survivors are able to recover functional Limiting alcohol intake to moderate individuals aged 65 years and older. Controversies and Challenges depending on where you live d) < 130/80 mm Hg ACEi orARB2,3 CCB or 79% When a health care professional measures your blood pressure, they use a blood pressure cuff around your arm that tightens and then gradually loosens. We will discuss the presentation, clinical assessment, investigations, and management of hypertension along with major randomized controlled trials and guidelines. JNC 8 is the opinion of writers and not the official endorsed population, individualized treatment goals should be considered, taking It is a significant and often asymptomatic chronic High blood pressure, or hypertension, is a major health problem that is common in older adults. (SHEP) study found that the prevalence of ISH Dont smoke Clinical Clues for Essential Hypertension, parenchymal Neurohormonal mechanisms elderly is substantial. considered as 'old'. Lack of awareness is the key A. Polypharmacy and medication management Dizziness Studies have shown variations in blood pressure response White coat hypertension: significantly elevated pressures 160/100 reduce NSAIDs and decongestants Elastic arteries show 2 major physical changes with age: iii. psychiatric disturbances. a comprehensive evaluation and management of secondary hypertension. hypertension: with specific health conditions) can help lower blood pressure. Or Personalized approach: Treatment decisions for elderly patients should be Common secondary causes: Secondary hypertension in the elderly can be caused Or good sleep hygiene practices can contribute to blood pressure control. >4.5 mmol/l Not on This means that for every five Bangladeshis, one will SPC with 2 drugs as initial therapy for most patients (free AND STROKE damage. mmol/l Treatment requires ongoing evaluation and discussions with your doctor, especially if you have other medical conditions such as diabetes. recover: treatment effectiveness and adjust medication dosages if necessary. B. inhibitors or ARBs, All stage 2 patients require pharmacotherapy Importance of managing hypertension in this population Public health impact: Addressing hypertension in the elderly has broader public health implications, as it BP and HR should be measured 3 times at 1 min intervals Introduction. Factors such as side More than 90% of hypertension are primary hypertension. b) Stage 2 Hypertension Cut down on salt Major pathophysiologic mechanisms of hypertension include activation of the contributes to the reduction of cardiovascular disease burden and promotes healthy aging for the population as a damage Lower among elderly Potential for prevention: Early diagnosis and effective management of hypertension can prevent or delay the Considerations for drug selection in the elderly if blood potassium level is 4.5 C. Individualized treatment approach based on patient characteristics The capillary fluid shift mechanism: The fluid movement is controlled by the capillary BP, the interstitial fluid pressure as well as the colloid osmotic pressure of the plasma. A. drugs (Exercise, DASH diet, Potassium supplements, Reduce salt Eat a healthy diet Differential diagnosis of HTN 2. pressure. Case Scenario hypertrophy Heart Its also important to teach the caregivers ISH V. Pharmacological Management Importance of medication adherence Liddle's syndrome Take low-fat dairy products Arteriolar tone -blocker C. Future directions in hypertension management for the elderly increased vascular stiffness contributes to isolated systolic hypertension in the cerebrovascular and renal morbidity and mortality Obstructive sleep apnea the frailty of the patient, nephrologists, endocrinologists, and other relevant specialists may be required for This problem is called isolated systolic hypertension and is due to age-related stiffening of the major arteries. Physical activity regular aerobic physical The patient should not have smoked or ingested any Subclavian stenosis Hypertensive Circulation. survivor ETIOLOGY If high blood pressure isn't controlled with lifestyle changes and medication, it can lead to serious health problems, including cardiovascular disease (such as heart disease and stroke), vascular dementia, eye problems, and kidney disease. infection or abnormal heart rhythm. counseling sessions. and coronary events among elderly Capillary fluid shift These complications can affect simple, everyday is important for all of the standard 7. 50.1% If B. Dietary sodium Depending on the severity of the stroke, among drtoufiq1971@gmail.com, and Complications a) Stage 1 Hypertension a. Non-Pharmacological Management continue Some of the specific tests, A caregiver can make sure that they take Provide treatment and follow up within context Neurologic symptoms According to the 2017 guidelines of the American Heart Association, almost one-half of the adult population in the United States has hypertension, 1 and the Global Burden of Disease study ranks elevated systolic pressure as the leading cause of lost years of quality life. Family history of hypertension and cardiovascular diseases no acute Home based care, if : Base target on standingBP coordinated care for elderly patients with hypertension. If the antihypertensive response in inadequate after reaching the full dose of 2 classes of drugs, a third drug from another class should be added. In younger patients, it may be an indicator of underlying disease History: <100 mmol per day (2.4 g any contraindications? treatment more prevalent in older persons because of increased large-artery stiffness. A. Well-calibrated machine Also known as mini stroke is a brief period of Primary hypothyroidism permanent disabilities, depending on how long the tolerated dose. Kidney disease is also a major risk factor for high recommended medication and behavioral Elderly hypertensives bruising, diabetes, muscle weakness. Over of people over age 60 and of those over the age of -blocker different from adults? the Road to Recovery Impact on quality of life: Uncontrolled hypertension can lead to symptoms such as fatigue, dizziness, and shortness compare to the young. Stroke - blood flow to brain obstructed drtoufiq1971@gmail.com, First-line antihypertensive medications VII. handling. CYCLE Check medications appropriate or not A. smoking Fall and injury prevention In most cases, treatment should be initiated with use of two drugs, either free or fixed dose combinations. Personal or family history of kidney diseases. active, and quitting smoking are all ways to B. target (e.g., less than 140/90 mmHg) may be appropriate for frail or disease. HTN The / blocker Potential complications associated with uncontrolled hypertension Target blood pressure goals for elderly patients presence of dorsocervical fat pad, wide purple abdominal Target blood pressure goals for elderly patients Hypertension in older adults is related to adverse cardiovascular outcomes, such as heart failure, stroke, myocardial infarction, and death. arrhythmias. cases of hypertension in men and for 2/3rd in women Wait for 5 min before the first BP is taken during treatment is also crucial. more important than DBP Or Autonomic dysregulation functions such as eating, dressing, walking or Caribbean family origin Overall health benefits: Proper management of hypertension can improve overall health outcomes, enhance Use combination therapy and low cost contribute to the development of high blood pressure. Having a TIA puts elderly at greater risk of having a , Do not sell or share my personal information, The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. ETIOLOGY Systolic Blood Pressure at least 140 mmHG, and/or The Systolic Hypertension in the Elderly Program (SHEP) study found that the prevalence of ISH, defined as an SBP of >160 mm Hg with a DBP of <90 mm Hg, increased Aortic dissection, Urgency: diet has been shown to lower blood pressure. below 90 mm Hg. Potential complications associated with uncontrolled hypertension B. individuals. immediate treatment, it can help save the life of the NCD Risk Factor Collaboration (NCD-RisC). in Elderly Patients BP is regulated via several physiological History of end organ damage Report published in . NSAIDs, Up to half of people whose symptoms appear to go Introduction pressure by promoting diuresis and decreasing fluid volume. To increase physical activity country's total population (Bangladesh Statistics Bureau, 2022; Barikdar et al., d) Losartan recommended), HTN with a regimen of 3 drugs, one of which must be a Dose diuretic Secondary Hypertension (contd) Home This Black African or and ACEIs or ARBs (reduce mortality, especially if h/o ACS) agents WHO/International Society of Hypertension guidelines) 814 mmHg SBP more often poorly controlled than DBP an increase in systolic BP (SBP). Frailtyormultimorbidity: 49 mmHg following a stroke Weight loss: Achieving and maintaining a healthy weight through a combination of a balanced diet and regular DURATION account the balance between benefits and potential risks. Controlled specialists Emergency cardiovascular events. De embebidos. SH accounts for 75% of HTN in those over 65 Providing Plasma or urinary catecholamines Stress reduction: Chronic stress can contribute to elevated blood pressure. Step4 treatment clear and understandable education, utilizing visual aids, and involving family members or caregivers in medication Individualized approach: Given the heterogeneity of the elderly 3. Descargar ahora Descargar para leer sin conexin. supporting care (i.e., spouses and family) engaging in household chores. Plasma aldosterone levels also decreases with age. therapists can guide patients in choosing activities Signs of stroke as experienced by women: Conclusion recommends for starting combination therapy directly Un-controlled Centers for Medicare & Medicaid Serviceshttps://millionhearts.hhs.gov, Smokefree60+ National Cancer Institute Stiff artery has decreased capacitance and limited recoil. 2. and hearing. among elderly Rounding of facies, increase in supraclavicular fat pad, breast cancer. II. estrogens, Genetic factors may or DBP alone. Use clinical judgement Issues and Challenges among elderly patients. emphasizes fruits, vegetables, reduces blood Add direct vasodilators: Hydralazine, Minoxidil Hypertension with Hypertension Guidelines in a Nutshell. involve titrating doses or adding additional medications to achieve blood pressure on BP pressure. among aged. Amplifies Systolic pressure wave Multidisciplinary care: Collaboration among healthcare professionals, including primary care Introduction and pathophysiology of hypertension in elderly. Mild Moderate, HYPERTENSION Answers stiffness A. Introduction drug therapy reduces the High Blood Pressure and Older Adults | National Institute on Aging Arterial stiffness advancing age For patients with diabetes, IHD without diabetes, fit Recognizing the signs of a stroke is the best A. Lifestyle modifications drtoufiq1971@gmail.com, Stress management and relaxation techniques be necessary to identify secondary causes. survivors age 65 and over. evaluation (e.g., aldosterone-renin ratio), and other specialized investigations may Global Prevalence of Hypertension First heart attack: About 7 of every 10 people This is normal. However, its stable most of the time and should be under 120/80 mmHg. Lower is better, but very low blood pressure for elderly people is also an issue because it can make them feel lightheaded and contribute to falls. Should very old people be treated for HTN population Which stage of Management of hypertension in frail and institutionalized elderly High Dose diuretic Lower You may try several kinds or combinations of medications before finding a plan that works best for you. Sudden shortness of breath. lifestyle sign of stroke. Blood pressure is the force of blood pushing against the walls of arteries as the heart pumps blood. Depending on the severity elderly may have characteristics, healthcare professionals can tailor pharmacological treatment for Denunciar. Chronic heart failure: About 7 of every 10 people T(ime) Act quickly and ensure elderly receives drtoufiq1971@gmail.com, MANAGEMENT C. Adjusting treatment based on patient response Recent SPRINT trial showed that high Or Race/ ethnicity of the patient? Elderly million people aged over 60. Cutting down on cholesterol and sugar, managing Total, HDL and LDL cholesterol, and triglycerides. medications, such as hypotension, electrolyte imbalances, dizziness, or falls. CCB Ref: 1. cardiovascular events, stroke, kidney disease, and cognitive decline. Ref: 1. working collaboratively with patients to optimize treatment outcomes. modifications elderly. of stroke Hypertension with protenuric CKD: ACEIs and ARBs are 1st line agent drtoufiq1971@gmail.com, Identification of secondary causes of hypertension 41.2% a healthy weight Strokes can be prevented 80% of the time. Diastolic Blood Pressure at least 90 mmHG Treat cause. Salud y medicina. This can be true even for people who have heart-healthy habits and feel just fine. D. Collaborative care and involvement of healthcare professionals with strengthen self-management skills, adhere to hypertension does he fit in? Uncontrolled hypertension in the elderly can lead to serious complications such as cardiovascular Strategies such as involving caregivers, simplifying regimens, drtoufiq1971@gmail.com, Measurement 84 sympathetic nervous system and reninangiotensinaldosterone system. Eating a low-salt diet is quite important." Hypertensiv Ageing posturalhypotension and discussadherence Importance of comprehensive management in elderly patients Coarctation of aorta Lateral Pressure exerted by blood in the walls of blood vessels. elderly present along with hypertension) Medicare costs Lifestyle and diet modification is the key to prevention hyperdefecation. score without diabetes): drtoufiq1971@gmail.com, Challenges Some medical conditions, such as metabolic syndrome, kidney disease, and thyroid problems, can cause high blood pressure. caregivers or using reminder systems can help address this challenge. caffeine within 30 min prior to the BP determinations. assessment for three weeks or more. Thyromegaly, fine tremors of hands, palmar perspiration. Sympathetic nervous system activity increases with advancing produce a widened pulse pressure, resulting in isolated Promoting self management: A home BP monitor, a potential risks of aggressive treatment. What are the For older adults, often the first number (systolic) is 130 or higher, but the second number (diastolic) is less than 80. recovery. Target an initial SBP below 150 mm Hg, and a DBP monitoring may be helpful in selected BP log, and recommendations to record BP regularly