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HYPERTENSION
AND THE ELDERLY
-Essential
hypertension is the most common cause of hypertention in the elderly.
Primary aldosteronism and atherosclerotic renovascular hypertension
should be considered in patients who develop hypertension when they are
older than age 60 and/or have hypertension that is difficult to control.
-The
same general guidelines used for younger patients should be used for the
elderly except that lower starting doses should be considered to avoid
antihypertensive side effects.
AUTONOMIC
OVERACTIVITY AND HYPERTENSION
-Hypertension
that is new or exacerbated by various disorders that produce autonomic
nervous system overactivity.
The patients may show elevated blood pressure that is associated with
tachycardia, anxiety, diaphoresis, tremor, and hyperventilation.
-Causes
include: raised intracranial pressure, spinal cord injury, head trauma,
meningitis,
temporal lobe epilepsy, toxic neuropathies, pheochromocytoma,
neuroleptic malignant syndrome, sympathomimetic agents, monoamine oxidase
inhibitors, and alcohol or sedative withdrawal.
-Elevated
intracranial pressure may lead to compression of the autonomic centers in
the brain stem and lead to the Cushing response that is a triad of
hypertension, irregular respiratory rate, and bradycardia.
The Cushing response may indicate impending brain herniation, unless
emergent action is taken to decrease the intracranial pressure.
-Alcohol
and/or sedative withdrawal may produce severe autonomic overactivity
associated with wide ranges in blood pressure that is related to the stress
of withdrawal.
The patients may also have tachypnea, confusion, mydriasis,
diaphoresis, tachycardia,
hallucinosis, and tremors.
Clonidine and B-blockers on a scheduled basis are the treatment of
choice since these agents block some of the stimulation to the autonomic
system.
Minoxidil hydralazine and other vasodilators should be avoided since
the vasodilation can stimulate the autonomic nervous system and make the
patient have increased confusion.
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