In this case the clinician should question why the patient is so hypertensive in the morning. Chinese trial on isolated systolic hypertension in the elderly. Among patients with an average age of 67 years with hypertension and left ventricular hypertrophy, the Losartan Intervention for Endpoint Reduction in Hypertension LIFE study 39 showed that losartan was associated with fewer strokes and composite cardiovascular outcomes compared with atenolol. High blood pressure, physical and cognitive function, and risk of stroke in the oldest old: Sometimes there are cultural influences on what foods people eat, so it is important to take these into consideration. It results from virtually universal access to clean water, sanitation, waste removal, electricity, refrigerators and vaccinations, and continued improvement in health care. Chlorthalidone may be slightly more potent and more effective than hydrochlorothiazide in preventing cardiovascular morbidity and mortality, 35 , 36 but it is more likely to produce hypokalemia. Altered blood pressure homeostasis in advanced age:
High blood pressure, physical and cognitive function, and risk of stroke in the oldest old: I would ease the medications if they develop adverse effects. If her BP is elevated in the early morning but declines after standing up or eating a meal, her antihypertensive medications should be taken before she goes to bed at night. While this might seem obvious, a statistical perspective provides interesting insights into living and working in today's longevity revolution. Instead, I would focus my attention on treating the daytime BP. Sometimes there are cultural influences on what foods people eat, so it is important to take these into consideration. Am J Public Health. Reynolds, MD, Amy N. Diuretics Thiazide diuretics are the most widely studied and least expensive of antihypertensive agents. They are the preferred first-line treatment for African Americans like Ms H. Among patients with an average age of 67 years with hypertension and left ventricular hypertrophy, the Losartan Intervention for Endpoint Reduction in Hypertension LIFE study 39 showed that losartan was associated with fewer strokes and composite cardiovascular outcomes compared with atenolol. As shown in Table 1 , almost all classes of antihypertensive medications have been effective in reducing cardiovascular morbidity and mortality in elderly patients up to age 85 years when BP is lowered to the ranges discussed above. J Am Geriatr Soc. If hypertension is observed overnight, clinicians might chose to give a patient a short-acting antihypertensive medication before he or she goes to bed. Heart disease and stroke statistics update. I suggest measuring her BP during daily activities after posture change, meals, and medications to determine her BP profile. Maybe he or she has sleep apnea or a reversal of the normal circadian rhythm. Footnotes Supplemental content at jama. Clinical Crossroads receives no external support. These recommendations do not differ from those for younger patients. But as a society, we set cultural expectations for appropriate retirement ages decades ago, when many people in their 60s and 70s were unable to work and were considered "old" or "very old. The rationale for not using a thiazide as a first-line agent is that it has a potential for incontinence and hypokalemia. In this case the clinician should question why the patient is so hypertensive in the morning. Sometimes patients have a systolic BP of mm Hg first thing in the morning but as soon as they eat a meal, the systolic BP declines to mm Hg. Shoven suggests that reduced mortality rates correlate roughly with improved health and vitality at all ages, and can be used as a proxy measure for aging. And finally, if your chance of dying within the next year is 4 percent or higher, you might be considered "very old" or "elderly.
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