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Hypertension

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Geriatric Medicine

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Abstract

Hypertension is very common in older adults and causes significant morbidity and mortality. Treatment is very effective at reducing stroke, cardiac events, and mortality, even in the very old. Hypertension is defined as a systolic blood pressure > 130 mmHg or a diastolic blood pressure > 80 mmHg. Due to changes in physiology, comorbid conditions, increased susceptibility to side effects, and socioeconomic factors, blood pressure goals and treatments must be individualized for each older adult. The blood pressure goal in robust patients is systolic blood pressure < 130 mmHg. Nursing home residents and patients with advanced frailty or advanced cognitive decline likely need higher goals. Nonpharmacologic therapy should be implemented in all patients. First-line antihypertensive agents are angiotensin-converting enzyme inhibitors, non-dihydropyridine calcium channel blockers, thiazide diuretics, and angiotensin II receptor blockers. Comorbid conditions may influence choice of agents. Therapy requires close monitoring for potentially serious side effects, including electrolyte abnormalities, renal function, and orthostatic hypotension. Deprescribing should regularly be considered as cognition declines, frailty increases, or there are serious side effects from treatment. Involving caregivers in the education and management of hypertension is often essential due to frailty and/or cognitive decline. Use of an interprofessional team and telehealth for monitoring can be very helpful in the longitudinal care of older adults with hypertension.

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Authors and Affiliations

  1. Davis School of Medicine, University of California, Sacramento, CA, USA

    John C. Landefeld, Sharad Jain & Craig R. Keenan

Authors
  1. John C. Landefeld
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  2. Sharad Jain
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  3. Craig R. Keenan
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Corresponding author

Correspondence to Craig R. Keenan .

Editor information

Editors and Affiliations

  1. California Association of Long Term Care Medicine, Newbury Park, CA, USA

    Michael R. Wasserman

  2. Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA

    Debra Bakerjian

  3. Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA

    Sunny Linnebur

  4. Division of Geriatrics, SUNY Upstate Medical University, Syracuse, NY, USA

    Sharon Brangman

  5. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Matteo Cesari

  6. Section of Geriatric Medicine, Division of Internal Medicine, Department of Medicine, Cedars-Sinai, Beverly Hills, CA, USA

    Sonja Rosen

Section Editor information

  1. California Association of Long Term Care Medicine, Newbury Park, CA, USA

    Michael R. Wasserman M.D., CMD

  2. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Matteo Cesari MD, PhD

  3. Geriatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Matteo Cesari MD, PhD

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Landefeld, J.C., Jain, S., Keenan, C.R. (2024). Hypertension. In: Wasserman, M.R., Bakerjian, D., Linnebur, S., Brangman, S., Cesari, M., Rosen, S. (eds) Geriatric Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-74720-6_26

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  • DOI: https://doi.org/10.1007/978-3-030-74720-6_26

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-74719-0

  • Online ISBN: 978-3-030-74720-6

  • eBook Packages: MedicineReference Module Medicine

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