Hypertension in older persons

Hypertension in older persons
- BP goal for people > 60 is < 150/90
- Preferred antihypertensive drugs
  - Thiazide diuretic
  - Calcium channel blockers
  - ACE inhibitors or ARBs
- Caution use of NSAIDS

Hypertensive crisis
- SBP >180 mmHg and/or DBP >110 mmHg
  - Hypertensive urgency
    - Develops over hours to days
    - May not require hospitalization
  - Hypertensive emergency
    - Very severe problems can result if prompt treatment is not obtained
- Rate of rise more important than absolute value
- Causes of hypertensive crisis
  - Exacerbation of chronic hypertension
  - Renovascular hypertension
  - Preeclampsia, eclampsia
  - Pheochromocytoma
  - Drugs (cocaine, amphetamines)
  - Monoamine oxidase inhibitors taken with tyramine-containing foods
  - Rebound hypertension (from abrupt withdrawal of some antihypertensive drugs such as clonidine [Catapres] or -blockers)
  - Head injury
  - Acute aortic dissection
- Clinical manifestation
  - Hypertensive encephalopathy
    - Headache, nausea/vomiting, seizures, confusion, coma
  - Renal insufficiency
  - Cardiac decompensation
    - MI, HF, pulmonary edema
  - Aortic dissection
- Nursing and interprofessional management
  - Hospitalization
    - IV drug therapy: titrated to MAP
    - Monitor cardiac and renal function
    - Neurologic checks
    - Determine cause
    - Education to avoid future crisis

Role of Nursing Personnel

Registered Nurse (RN)
- Develop and conduct hypertension screening programs.
- Assess patients for hypertension risk factors and develop risk modification plans.

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