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.