VIII
- High blood pressure and special cases
8.1
- High blood pressure and sport
8.2
- High blood pressure and obesity
8.3
- High blood pressure and pregnancy
8.4 - High blood pressure and elderly
8.5
- High blood pressure and children
8.6
- High blood pressure and contraception
8.7
- Influence of hormones on high blood pressure (case of the post-menopausal
woman)
8.8 - Influence
of life style modification on blood pressure
8.4-
High blood pressure and elderly
Blood pressure increases
with age because the arteries become stiffer. Thus, high blood pressure
is a very frequent pathology in the elderly, concerning 15 to 25% of
the population. According to medical studies, people aged 60 and over
are considered old.
The more the arteries become stiffer, the more the maximal blood pressure (the
systolic one) increases compared to the minimal one (diastolic), which involves
an increase in the difference (pulse pressure). For example, a blood pressure
of 17/9 (170/90 mmHg), corresponds to a rise of the systolic blood pressure
and of a normal diastolic blood pressure.
The difficulty in the elderly
is represented by the extreme daily variation of the blood pressure,
depending in particular on the body position. Indeed, these subjects
often present a hypotension during the passage from the sitting or
lying position to the standing position (defined by a fall of more
than 20 millimetres of mercury between the 2 positions on the systolic
blood pressure). This hypotension is characterized by giddiness and
a great tiredness or fatigue, and impairs considerably the antihypertensive
drug therapy.
8.4.1- What is the reference
value?
Medical societies have fixed
a maximum limit at 160/90 millimetres of mercury (16/9), value above
which we speak about high blood pressure.
8.4.2- Is the high blood
pressure in the elderly more complicated than the high blood pressure
in the young subjects?
As previously described,
the blood pressure in the elderly fluctuates more than in the young
subject. The difficulty for the practitioner is to prescribe an antihypertensive
drug for instance which will not lower the blood pressure too much
in order to avoid the patient falling which could have dramatic consequences.
Because the elderly often
had high blood pressure for some time, the cerebral, cardiac, vascular
and renal damages are more frequent compared with younger subjects.
In fact, it is rather the
duration of the high blood pressure which induces organ damage more
than the age of the subject himself.
8.4.3- Is the antihypertensive
drug effective?
In terms of the reduction
of the blood pressure, the antihypertensive drug therapy is effective
in general, but many practitioner have wondered if the antihypertensive
drug could induce a reduction of the cardiovascular mortality in this
case.
Medical studies have shown
that a reduction of the blood pressure involves a reduction in the
cardiovascular mortality, in a very significant way. The aim of the
blood pressure value in this context is 140/90 millimetres of mercury.
This decrease of the cardiovascular risk is proportional to the decrease
of the arterial blood pressure.
8.4.4- How to treat?
It is very important to respect
the life style modifications (sport, physical activity, absence of
stress, sodium reduction, reduction of the consumption of coffee, tea...).
In the event of ineffectiveness
of this treatment, an antihypertensive drug therapy can be prescribed.
All the drugs can be given if they are well tolerated.
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last modified on : 28 sep 2003 |
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