Hypertension in
elderly
By:
Najla al-hagbani
1
Table of content
NO.
Page
1
Introduction
3
2
Causes
5
3
Sign and symptoms
6
4
Prevention
7
5
Treatment
8
6
Food contain high sodium
11
7
HTN and elderly
41
2
Introduction
Hypertension is a chronic medical condition in which the blood
pressure is elevated. It is also referred to as high blood pressure
or shortened to HT, HTN or HPN. The word "hypertension", by
itself, normally refers to systemic, arterial hypertension.
Hypertension can be classified as either essential (primary) or
secondary.
Essential or primary hypertension means that no
medical cause can be found to explain the raised blood pressure.
It is common. About 90-95% of hypertension is essential
hypertension.
Secondary hypertension indicates that the high blood pressure
is a result of (i.e., secondary to) another condition, such as
kidney disease or tumours (adrenal adenoma or
pheochromocytoma).
Persistent hypertension is one of the risk factors for strokes,
heart attacks, heart failure and arterial aneurysm, and is a
leading cause of chronic renal failure. Even moderate elevation
of arterial blood pressure leads to shortened life expectancy. At
severely high pressures, defined as mean arterial pressures 50%
or more above average, a person can expect to live no more than
a few years unless appropriately treated. Beginning at a systolic
pressure (which is peak pressure in the arteries, which occurs
near the end of the cardiac cycle when the ventricles are
contracting) of 115 mmHg and diastolic pressure (which is
minimum pressure in the arteries, which occurs near the
beginning of the cardiac cycle when the ventricles are filled with
blood) of 75 mmHg (commonly written as 115/75 mmHg),
cardiovascular disease (CVD) risk doubles for each increment of
20/10 mmHg.
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High Blood Pressure Overview
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Many people have high blood pressure and don't even
know it.
Public awareness of these has increased. High blood
pressure has become the second most common reason for
medical office visits in the United States.
Blood pressure is measured with a blood pressure cuff and
recorded as two numbers, such as 120/80 mm Hg
(millimeters of mercury).
The top, larger number is called the systolic pressure. This
is the pressure generated when the heart contracts
(pumps). It reflects the pressure of the blood against
arterial walls.
The bottom, smaller number is called the diastolic
pressure. This reflects the pressure in the arteries while
the heart is filling and resting between heartbeats.
Scientists have determined a normal range for both
systolic and diastolic blood pressure after examining the
blood pressure of many people.
As many as 60 million Americans have high blood
pressure.
Uncontrolled high blood pressure is indirectly responsible
for many deaths and disability resulting from heart attack,
stroke, and kidney failure.
According to research studies, the risk of dying of a heart
attack is directly linked to blood pressure, especially
systolic hypertension. The higher your blood pressure, the
higher your risk, even with blood pressure in the normal
range.
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Causes
Factors that can't be changed
Age: The older you get, the greater the likelihood that you
will develop high blood pressure, especially systolic, as y
arteries get stiffer.
Race: African Americans have high blood pressure more
often than whites.
Socioeconomic status: High blood pressure is also more
common among the less educated and lower socioeconomic
groups.
Family history (heredity): The tendency to have high blood
pressure appears to run in families.
Gender: Generally men have a greater likelihood of
developing high blood pressure than women. This likelihood
varies according to age and among various ethnic groups.
Factors that can be changed
Overweight (obesity): Obesity is defined as having a body
mass index (BMI) greater than 30 kg/m2. It is very closely
related to high blood pressure
Sodium (salt) sensitivity: Some people have high sensitivity
to sodium (salt), and their blood pressure goes up if they use
salt. Reducing sodium intake tends to lower their blood
pressure..
Birth control pills (oral contraceptive use): Some women
who take birth control pills develop high blood pressure.
Lack of exercise (physical inactivity): A sedentary lifestyle
contributes to the development of obesity and high blood
pressure.
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Drugs: Certain drugs, such as amphetamines (stimulants), diet
pills, and some pills used for cold and allergy symptoms, tend
to raise blood pressure.
Signs &Symptoms
Most of the time, there are no symptoms. Symptoms that
may occur include:
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Chest pain
Confusion
Ear noise or buzzing
Irregular heartbeat
Nosebleed
Tiredness
Vision changes
 These may be signs of a complication or dangerously high
blood pressure called malignant hypertension.
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Prevention
The degree to which hypertension can be prevented depends on
a number of features including: current blood pressurelevel,
changes in end/target organs (retina, kidney, heart - among
others), risk factors for cardiovascular diseases and the age at
presentation. Unless the presenting patient has very severe
hypertension, there should be a relatively prolonged assessment
period within which repeated measurements of blood pressure
should be taken. Following this, lifestyle advice and nonpharmacological options should be offered to the patient, before
any initiation of drug therapy.
The process of managing hypertension according the guidelines
of the British Hypertension Society suggest that nonpharmacological options should be explored in all patients who
are hypertensive or pre-hypertensive. These measures include;
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Weight reduction and regular aerobic exercise (e.g.,
walking) are recommended as the first steps in treating
mild to moderate hypertension. Regular exercise improves
blood flow and helps to reduce resting heart rate and blood
pressure. Several studies indicate that low intensity
exercise may be more effective in lowering blood pressure
than higher intensity exercise.
Reducing dietary sugar intake.
Reducing sodium (salt) in the diet may be effective: It
decreases blood pressure in about 33% of people (see
above). Many people use a salt substitute to reduce their
salt intake.[136]
DASH diet (dietary approaches to stop hypertension)
which is rich in fruits and vegetables and low-fat or fatfree dairy foods. This diet has been shown to be effective
based on research sponsored by the National Heart, Lung,
and Blood Institute. In addition, an increase in daily
calcium intake has the benefit of increasing dietary
potassium, which theoretically can offset the effect of
sodium and act on the kidney to decrease blood pressure.
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This has also been shown to be highly effective in
reducing blood pressure.
coffee drinking (caffeine ingestion) also increases blood
pressure transiently but does not produce chronic
hypertension.
Reducing stress, for example with relaxation therapy,
such as meditation and other mindbody relaxation
techniques, by reducing environmental stress such as high
sound levels and over-illumination can be an additional
method of ameliorating hypertension.
Treatment
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Many people can lower their blood pressure significantly
with lifestyle changes, such as weight loss and exercise,
but most still need medication to keep their blood pressure
in the healthy range.
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Whichever therapy you choose, it is important to have
your blood pressure checked regularly to make sure that
your treatment is working.
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Measure your blood pressure three times, two minutes
apart. The third measurement is usually the most accurate.
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Self-Care at Home
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Lifestyle options include changing what you eat and your
activity level.
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Maintain a healthy weight:
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If you are overweight or obese, lose weight. Aim for a
healthy weight range for your height and body type. Your
health care provider can help you calculate a target
weight. Even a small amount of weight loss can make a
major difference in lowering or preventing high blood
pressure.
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Choose foods low in calories and fat. Fat is a concentrated
source of calories. You should cut down on butter,
margarine, regular salad dressing, fatty or red meats, the
skin of poultry, whole milk, cheese, fried foods, ice
cream, many cookies, cakes, pastries, and snacks.
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Instead, choose baked, broiled, or poached chicken and
turkey (without skin), fish, lean cuts of meat (such as
round or sirloin); skim, 1%, or evaporated milk; lower fat,
low-sodium cheeses; fresh, frozen, or canned fruit or
vegetables (without butter, cream, or cheese sauces); plain
whole wheat rice and pasta; whole wheat English muffins;
whole wheat bagels; whole wheat sandwich bread and
rolls; soft tortillas; cold (ready-to-eat) and hot whole-grain
cereals (avoid "instant" types, which are high in sodium).
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Choose foods high in starch and fiber. Try fruits,
vegetables, whole-grain cereals, whole wheat pasta, rice,
and dry peas and beans.
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Exercise or increase physical activity.
Physical activity burns calories, helps you lose weight, and
reduces stress.
Physical activity reduces total cholesterol and bad cholesterol
(LDL) and raises the good cholesterol (HDL).
The American Heart Association (AHA) recommends at least
30 minutes of exercise every other day .
You can fit physical exercise into your daily routine.
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Use the stairs instead of the elevator.
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Park farther away from the store or office.
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Work in the yard or garden.
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Clean house.
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Wash the car the old-fashioned way.
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Go dancing.
Medical Treatment
Medication is an important part of blood pressure control for
almost everybody with high blood pressure. Many people
cannot keep their blood pressure in the healthy range by lifestyle
changes alone.
Only 21% of people with high blood pressure are on blood
pressure medicines and have their pressure adequately
controlled.
At least 16% of people with high blood pressure are not on
any medication.
Approximately 28% are taking medicines incorrectly, and
their blood pressure is uncontrolled.
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Foods High in Sodium
Meat, Poultry, Fish and Other Meat Substitutes
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Luncheon and cured meats including processed
turkey/chicken, ham, bologna, salami, bacon, Canadian
bacon, corned beef, pastrami, liverwurst, frankfurters,
sausages, dried meat or dried fish.
Canned foods including chicken, tuna and salmon,
shellfish such as shrimp, crab, clams oysters, scallops and
lobster.
Soy protein products including marinated tofu or miso.
Dairy
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Cheese, in particular processed cheeses including
American and other processed cheese products, blue
cheese, Roquefort parmesan cheese, feta cheese and
cottage cheese.
Milk-based drinks including buttermilk, Dutch process
cocoa and instant cocoa mixes.
Main Dish Items
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Commercially prepared main entrees including most
frozen dinners or frozen main entrees, pot pies, canned
main entrees such as hash, stew, chili, entrees with
seasoning mixes such as macaroni and cheese.
Most Asian foods including Chinese and Japanese foods
made with teriyaki or soy sauce; and East Indian, Thai and
Vietnamese unless prepared without added sauces
containing salt or sodium products.
Most Mexican foods including tacos, enchiladas, burritos
and tamales.
Pizza, lasagna, manicotti, ravioli, quiche, soufflés, blintzes
and cheese rarebit.
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Grains, Cereals, Soups and Snack Foods
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Cereals and instant hot cereals, cold cereals containing 200
mg or more of sodium.
Salted snack foods salted pretzels, salted crackers and
chips, salted popcorn.
Bake goods including cakes, cookies, pies, pastries, sweet
rolls, doughnuts, pancakes, waffles, biscuits and muffins.
Grains including rice or noodles with seasoning packets
and sauces, such as Ramen noodles, rice pilaf, instant
potatoes and stuffing mix.
Soups including canned or packaged.
Vegetables
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Canned including vegetables, vegetable juices, vegetables
with seasoned sauces, pickled vegetables, olives, pickles
and sauerkraut.
Canned beans including kidney and garbanzo.
Potatoes including au gratin, scalloped, packaged with
sauces and seasoning mixes.
Spices, Condiments and Sauces
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Spices and seasonings including salt, seasoning salts such
as garlic, onion and celery salt, meat tenderizers,
monosodium glutamate (MSG) and bouillon.
Sauces including soy sauce, teriyaki sauce, Worcestershire
sauce, steak sauce, barbecue sauce, smoke-flavored
sauces, gravies, marinades, pasta sauces like marinara and
alfredo, chili sauce, cocktail sauce, tomato puree and
tomato sauce.
Condiments and dressings including pickle relish, catsup,
mayonnaise, commercial and packaged salad dressings.
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Food Additives
Sodium is often added to food in other forms besides salt such
as the following:
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Monosodium glutamate (MSG): a flavor enhancer
Baking soda and baking powder: found in many baked
goods
Disodium phosphate: found in quick-cooking cereals and
processed cheeses
Sodium alginate: used in many chocolate milks and ice
creams
Sodium benzoate: used as a preservative in many
condiments such as relishes, sauces and salad dressings
Sodium hydroxide: used in food processing for softening
and loosening skins of olives and certain fruits and
vegetables
Sodium nitrite: used in curing meats and sausages
Sodium propionate: used in some breads and cakes to
inhibit mold growth and in pasteurized cheese
Sodium sulfite: used to bleach certain fruits such as
maraschino cherries and glazed or crystallized fruits to be
artificially colored; as a preservative in some dried fruits
such as prunes
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Hypertension and elderly
The incidence of hypertension in the geriatric population is very
high and is a significant determinant of cardiovascular risk in
this group. The tendency for blood pressure to increase with age
in westernized societies such as the United States may depend
on environmental factors such as diet, stress, and inactivity .Our
population tends to become more obese; to consume relatively
greater amounts of sodium and lesser amounts of potassium,
calcium, and magnesium; and to decrease exercising with
increasing age. Senescent changes in the cardiovascular system
leading to decreased vascular compliance and decreased
baroreceptor sensitivity contribute not only to rising blood
pressure but also to an impairment of postural reflexes and
orthostatic hypotension .The hallmark of hypertension in the
elderly is increased vascular resistance. Greater vascular
reactivity in the elderly hypertensive patients may reflect
decreased membrane sodium pump activity and decreased betaadrenergic receptor activity as well as age-related structural
changes. Treatment of diastolic hypertension in the elderly is
associated with decreased cardiovascular morbidity and
mortality.
Although treatment of systolic hypertension may not decrease
immediate cardiovascular mortality, it appears to decrease the
incidence of stroke. The initial therapeutic approach to the
elderly hypertensive patient should generally consist of a
reduction in salt and caloric intake and an increase in aerobic
exercise, i.e., walking.
-Drug therapy should be initiated with lower doses of
medication with a special concern about orthostatic hypotension
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Goal
Control HTN among elderly pt during 2010-11 by 15% at
KKUH.
Objective
By the end of the program the pt will be able to :
 Define and list the symptom & complication of HTN.
 Identify the relationship between HTN and dietary
pattern.
 Monitor his BP.
 Demonstrate how to use sphygmomanometer.
 List the variety source of sodium in food.
 Identify the medication that contain high amount of
sodium.
 Returned for follow-up visits.
 Complain with the treatment.
Target group
Elderly patient with his family or care caver.
Location
The dietitian clinic at KKUH at 2nd floor and waiting area.
Time
start from 2010 until the end of 2011
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Team member:
Dietitian, health educator, physician, nurse, pt family or care
caver , pharmacies, social work, other pt.
Plan
Program will implement through individual teaching and group
teaching.
1-individual teaching:
Objective:
By the end of the program the pt will be able to:
 Define and list the symptom & complication of HTN.
 Identify the relationship between HTN and dietary
pattern.
 Monitor his BP.
 Demonstrate how to use sphygmomanometer.
 List the variety source of sodium in food.
 Identify the medication that contain high amount of
sodium.
 Returned for follow-up visits.
 Complain with the treatment.
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Session plan:
Each pt will receive 5 session during 1 month & 1 week in The
dietitian clinic at KKUH at second floor.
Session no.
Session 1
Session 2
Session 3
Session 4
Session 5
Week no.
Week 1
Week 2
Week 3
Week 4
Week 5
Time in session
30 minute
30 minute
20 minute
30 minute
15 minute
Session 1: (30 minute)
I will give Information about HTN, causes, symptom(chest pain
,confusion…) and complication .(giving brochure that contain
this information).Evaluate by asking questions related to
information given . (see page 5,6)
Session 2 :(30 minute)
I will informed the pt how his/her diet will effect there BP these
should done in front of the care caver that had the responsibility
of feed those elderly pt.(giving printed material that contain
food high in sodium to be avoided).Evaluate by display food
model to choose what food had low or high sodium(see page11)
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Session 3: (20 minute)
Teach the pt how to use sphygmomanometer and monitor
his/her blood pressure these done by display a video that shows
the manner. Evaluated by simply asking the pt or care caver to
demonstrate the manner again.
Session 4:(30 minute)
Will help the pt to identify the food that is high in sodium (meet
,cheese, canned fruit or vegetable…) and also medication that
have high amount of sodium that most of people never know
about it.(giving the printed material and papers that contain this
information).Evaluated by asking the pt to list the food and
medications that contain high sodium.(see page 11)
Session 5:( 15 minute)
Returned for follow-up visits more frequently. and check his
complain with the treatment.
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2- Group teaching:
Session plan:
Will done in waiting area, 1 session every month.
Objective:
By the end of the program the pt will be able to:
 Define and list the symptom & complication of HTN.
 Identify the relationship between HTN and dietary
pattern.
 Monitor his BP.
 Demonstrate how to use sphygmomanometer.
 List the variety source of sodium in food.
 Identify the medication that contain high amount of
sodium.
 Returned for follow-up visits.
 Complain with the treatment.
Session
Giving the pt the most important information in simple way
about HTN (cause, symptoms, complication…) see
page(5,6).provide the needed brochure and papers that contain
this information and others (food and medications contain high
sodium).see page (11)
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Material
 brochure that contain all need Information about HTN.
 Video that explain how to use sphygmomanometer.
 printed material contain food high in sodium to be
avoided.
 Paper contain names of some medications that contain
high amount of sodium.
Tools
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Place (clinic).
Brochure.
Food model.
Sphygmomanometer.
Video.
TV.
Referral
Office no. 01-4500012
Mobile no.0556070407
Email :najla-ali@hotmail.com
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Evaluation
Evaluate the understanding of what is giving in each session.
 This done by asking questions if interest , ask the pt to
demonstrate usage of Sphygmomanometer and pre and
post test evaluation.
 We can measure BP of pts every session to see if they
complain to treatment plan.
 if there is any problem we can correct and Reevaluate
each time.
Documentation
Documentation after each session in file . giving the pt schedule
about how will the program perform.
report at the end of the program will be available to others.
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