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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