Hypertension is one of the most common health conditions affecting Americans. An estimated 70% of seniors over the age of 65 suffer from high blood pressure, often without realizing it. Because hypertension is a primary risk factor for many serious medical conditions including stroke and heart attack, keeping it under control is essential for maintaining good health. As a CDPAP caregiver, you have an essential role in helping your loved one manage blood pressure. This guide tells you more about hypertension and how medication and lifestyle changes can help keep blood pressure at optimal levels.
What is Hypertension?
Hypertension, or high blood pressure, is a common condition where the pressure on blood vessels is constantly high. Each time the heart beats, it pumps blood into the arteries. The more blood your heart pumps and the narrower your arteries, the higher the pressure that the blood exerts against the artery walls. While it is normal for blood pressure to fluctuate slightly throughout the day, if it stays high over time, it can damage your blood vessels, heart, and kidneys.
Systolic and diastolic pressures
Blood pressure is at its highest when your heart beats and pumps the blood. This is systolic pressure. When your heart is at rest between beats, your blood pressure falls. This is known as diastolic pressure.
How is blood pressure measured?
Systolic and diastolic pressures are measured in millimeters of mercury (mmHg). For example, 120/80 mmHg means that the systolic pressure is 120 and the diastolic pressure 80. In a blood pressure reading, the systolic value always comes before the diastolic value.
What is considered high blood pressure?
High blood pressure or hypertension occurs when the blood pressure exceeds 140/90 mmHg.
Prehypertension
Mild hypertension, where the blood pressure is between 120/80 mmHg and 139/89 mmHg, is known as prehypertension. This condition increases the risk of hypertension. People with prehypertension can introduce lifestyle changes like eating a healthy diet, managing weight, and physical exercise to lower their blood pressure.
Hypertensive crisis
A hypertensive crisis occurs when blood pressure is higher than 180/120 mmHg. People with hypertensive or coronary heart disease, a somatoform disorder, as well as individuals who take large doses of antihypertensive medications or don’t take prescribed drugs are at higher risk of a hypertensive crisis. This condition is often accompanied by symptoms like weakness, chest pain, shortness of breath, and difficulty speaking and is potentially life threatening. American Heart Association recommends calling 911 in case of a hypertensive emergency.
Blood pressure range chart
| Category | Blood pressure |
| Low blood pressure | <90/60 mmHg |
| Normal blood pressure | <120/80 mmHg |
| Elevated blood pressure | 120-129/< 80 mmHg |
| Stage 1 hypertension | 130-139 mmHg/80-89 mmHg |
| Stage 2 hypertension | ≥140 mmHg/ ≥ 90 mmHg |
| Hypertensive crisis | ≥180/120 mmHg |
Types of hypertension
There are two main types of hypertension: primary and secondary.
Primary or essential hypertension is the most common type of high blood pressure. It develops over time as you get older and has no clear cause.
Secondary hypertension is caused by other medical conditions such as kidney disease or tumors or by the use of certain medications. It usually improves if the condition is treated or when the patient stops taking the medications that are causing high blood pressure.
The causes of hypertension
The most common causes of hypertension are:
- Obesity
- Smoking
- Excessive alcohol intake
- Lack of physical activity
- High salt intake levels
- Calcium, potassium, or magnesium deficiency
- Vitamin D deficiency
- Diabetes
- Chronic kidney disease
- Adrenal and thyroid conditions
- Stress
- Aging.
Some individuals are genetically predisposed to hypertension. High blood pressure is more prevalent among African-Americans, who also experience an earlier onset of the condition.
Symptoms of hypertension
The most common symptoms of hypertension include:
- Headaches
- Fatigue
- Confusion
- Dizziness
- Nausea
- Vision problems
- Chest pains
- Irregular heartbeat
- Breathing problems
- Blood in the urine
However, many cases of high blood pressure are asymptomatic, which is why it is important to have periodic blood pressure screenings.
How is hypertension diagnosed?
The only way your loved one can find out if they have hypertension is to get regular blood pressure checks from a health care provider. The provider will use a gauge, a stethoscope, and a blood pressure cuff and take several readings at separate appointments before making a diagnosis. Having blood pressure checked regularly is even more important for people who are at a higher risk of developing hypertension.
Once diagnosed, it is essential to treat hypertension early. Here’s why.
Why Is Treating Hypertension So Important?
Hypertension is known as the silent killer because high blood pressure is often not accompanied by any noticeable symptoms. Most people don’t know that they have hypertension until they have their blood pressure checked by a medical professional.
If blood pressure stays high over time, it puts extra strain on blood vessels, heart and other organs, possibly leading to serious health problems. Uncontrolled high blood pressure increases the risk of many serious and potentially life-threatening health conditions, such as:
- Heart disease
- Heart attack
- Stroke
- Heart failure
- Peripheral arterial disease
- Aortic aneurysm
- Kidney disease
- Arteriosclerosis
- Arrhythmia.
In addition, the National Institutes of Health (NIH) reports that there is a possible link between high blood pressure and dementia. Reducing blood pressure even slightly can help lower the risk of these health conditions.
There are many reasons for keeping blood pressure under control:
Improve heart health
People who suffer from hypertension are three times more likely to die from heart disease than people with normal blood pressure.
Decrease the risk of a stroke
Hypertension causes damage to arteries, increasing the chances of a stroke. Research shows that 77% of people who have their first stroke also have high blood pressure.
Prevent chronic kidney disease
High blood pressure can cause stretching the filtering system of the kidneys, preventing them from filtering blood efficiently. Chronic kidney disease will often require dialysis or a kidney transplant.
Reduce out-of-pocket-expenses
According to the Centers for Disease Control and Prevention (CDC), high blood pressure costs the United States about $131 billion each year and around 10% of the total annual drug expenditure is spent on antihypertensive medications. By keeping blood pressure under control, patients can significantly reduce their future medical costs.
Categories of Elderly People with Hypertension
Hypertension drastically increases with age, affecting approximately 70% of the elderly population between the ages of 65 and 79.
In people considered as very old, above the age of 80, the prevalence of hypertension increases to 74%.
Blood Pressure Goals for the Elderly
According to the American Heart Association (AHA), people aged 65 or older should ideally have blood pressure lower than <130/80 mm Hg.
People aged 80 years and older are recommended to maintain blood pressure below 150/90 mm Hg. However, the target goal is less than 140/90 mmHg for anyone who has diabetes or chronic kidney disease.
Older adults with blood pressure higher than the recommended limits are often treated with medications. Read on to learn more about the types of antihypertensive drugs commonly used to treat high blood pressure.
Pharmacotherapy to Treat Hypertension
If the doctor estimates that your loved one’s blood pressure is high enough to need medicine, they will prescribe blood pressure drugs called antihypertensives. Note that there are no FDA-approved over-the-counter medicines for high blood pressure.
Several different types of medications are used for treating hypertension:
Diuretics
Diuretics, also known as water pills, help the body get rid of excess salt and water, which decreases the amount of fluid flowing through the veins and arteries and reduces blood pressure. The most commonly prescribed diuretics are Thiazides, such as Chlorthalidone Hydrochlorothiazide (Microzide), Metolazone, and Indapamide.
Beta blockers
Beta blockers work by blocking the effects of the hormone adrenaline. They cause the heart to beat with less force, which lowers blood pressure. Beta blockers also help open up veins and arteries to improve blood flow. Commonly prescribed beta blockers for treating hypertension include Sectral (Acebutolol), Tenormin (Atenolol), and Kerlone (Betaxolol).
ACE inhibitors
Angiotensin Converting Enzyme (ACE) inhibitors help the body produce less of the chemical angiotensin, a substance that causes the arteries to narrow. These drugs dilate the blood vessels and lower the blood pressure. While long-acting ACE inhibitors like Lisinopril require less frequent dosing, short-acting ACE inhibitors such as Captopril need to be taken multiple times per day.
Calcium channel blockers
Calcium channel blockers prevent calcium from entering the muscle cells of the heart and arteries which in turn helps the blood vessels dilate, lowering blood pressure. Dihydropyridine calcium channel blockers, such as Amlodipine, Felodipine, and Lacidipine, are a common choice for the treatment of hypertension.
Alpha blockers
Alpha blockers lower blood pressure by keeping the hormone norepinephrine from tightening the muscles in the walls of smaller arteries and veins. They help improve blood flow and lower blood pressure. The most common alpha blockers used to treat high blood pressure are Doxazosin (Cardura), Prazosin (Minipress), and Terazosin.
Alpha blockers are typically not the first treatment option for high blood pressure. They are typically used in combination with other drugs, such as diuretics, when high blood pressure is difficult to control.
Central agonists
Central agonists help decrease the blood vessels’ ability to contract, thereby helping to lower blood pressure. The examples of commonly prescribed central agonists include Clonidine (Catapres), Guanfacine (Intuniv), and Methyldopa.
The type of medication prescribed depends on the individual and any underlying medical conditions they may have. Taking more than one antihypertensive medication in low doses is often more effective in treating high blood pressure than taking larger doses of one single drug.
It is important to follow recommendations carefully and report any side effects to your loved one’s healthcare provider. Below, we list the most common side effects and precautions for hypertension medications:
| Antihypertensive drug | Common side effects | Precautions |
| Diuretics | Too little or too much potassium in the bloodLow sodium levelsHeadacheDizzinessThirstIncreased blood sugarMuscle crampsIncreased cholesterolSkin rashDiarrhea | Some medications might interact with diuretics so make sure to inform the doctor if your elderly relative has any of the following conditions:DiabetesPancreatitisLupusGoutKidney problemsFrequent dehydration |
| Beta-blockers | DizzinessWeaknessDrowsinessFatigueCold hands and feetDry mouth, skin, or eyesHeadacheUpset stomachDiarrheaConstipation | Inform the healthcare provider if your loved one has asthma as beta-blockers may trigger a severe asthma attack.Drinking alcohol and caffeine can affect how beta-blockers work and should be avoided when taking this type of medication. |
| ACE inhibitors | Dry coughDizzinessLightheadednessVomitingDiarrheaElevated potassium levels in the bloodRenal impairmentSwelling under the skin | ACE inhibitors should not be taken by patients with kidney failure or who have a previous history of angioedema or hypersensitivity to this class of drugs, as in this case their side effects can be life-threatening. |
| Calcium channel blockers | Weight gainSwelling in legs, feet, or anklesNumbness or a tingling sensation in the feet or handsDizzinessIncreased appetiteConstipationDrowsinessA rapid, slow, or irregular heartbeatCoughing, wheezing, or problems with breathing or swallowingNauseaStomach discomfort | Calcium channel blockers may interact with other drugs, vitamins, and supplements, so you should inform the doctor if your senior is taking any other medications. Calcium channel blockers should always be taken with a meal or a glass of milk to protect the stomach. However, grapefruit juice may interact with some calcium channel blockers and increase the concentration of the medicine in the blood and worsen the side effects. |
| Alpha blockers | WeaknessHeadachePounding heartbeatDizziness | Alpha blockers can increase or decrease the effects of other medications. It is important to report taking any drugs to the healthcare provider. |
| Central agonists | Abnormally slow heart rateConstipationDizzinessDrowsiness Dry mouthFatigueFeverHeadache | Patients who suddenly stop taking central-acting agents may experience a dangerous increase in blood pressure. |
Medication management
Statistics show that one out of four patients with hypertension either don’t take blood pressure drugs as recommended or don’t take them at all. As a caregiver, you should help the senior understand why it is important to take the prescribed antihypertensives. It is essential to establish good habits around taking medications regularly, even though this may be challenging if your loved one has no high blood pressure symptoms.
Treating hypertension in very old patients
Doctors often choose not to treat patients aged 80 and older for hypertension due to associated risks of side effects such as postural hypotension and dizziness that can lead to falls and injury. These consequences may be more serious than the risk of not treating high blood pressure. What’s more, very old adults often suffer from multiple chronic health conditions and take additional medications which may interact with antihypertensives.
Besides medications, blood pressure can often be lowered by introducing some simple lifestyle changes.
How to Lower Blood Pressure for the Elderly
An important part of your role as a caregiver is to help your loved one develop heart-healthy habits, while at the same time keeping in mind their individual needs and limitations. The best way for seniors to control their high blood pressure is to maintain a healthy weight, stay active, and manage stress levels. A healthy lifestyle can delay or prevent that rise in blood pressure. Research shows that a healthy lifestyle almost halves the need for blood pressure medications.
Increase physical activity
Current guidelines recommend that older adults, including individuals with hypertension, engage in at least 150 minutes of moderate intensity physical exercise per week, at least five days a week. If they are already active, they should aim for an additional 75 minutes of vigorous intensity activity per week. Examples of activities suitable for seniors are walking, jogging, cycling, and swimming.
Eat healthy diet
An essential part of a high blood pressure treatment plan is eating a healthy diet. People who suffer from hypertension should avoid trans fats, animal fats, and hydrogenated vegetable oils. Fats in oily fish and olive oil have positive effects on the heart, however, anyone with high blood pressure should still include these in their total fat intake.
Recommended foods include:
- Whole grain, high fiber foods
- A variety of fruits and vegetables
- Beans, pulses, and nuts
- Low-fat dairy products
- Skinless poultry
- Fish rich in omega-3
- Non-tropical vegetable oils such as olive oil.
Limit sodium intake
The American Heart Association recommends a maximum sodium intake of 1,500 mg per day for most adults, and in particular for people who have high blood pressure. It is important that you pay attention to food labels and help your elderly loved one choose low-sodium options when grocery shopping and cooking.
The DASH diet
The US National Heart, Lung, and Blood Institute (NHLBI) recommends the Dietary Approaches to Stop Hypertension (DASH) diet for people with hypertension. The DASH diet is a balanced eating plan that helps lower high blood pressure, improve levels of fats in the bloodstream, and reduce the risk of cardiovascular disease. It focuses on eating fruits, vegetables, whole grains, in addition to fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils. The plan also limits foods high in saturated fats, such as red meats, full-fat dairy products, and tropical oils including coconut and palm oils, as well as sugary drinks and sweets.
The NHLBI has published a series of DASH-diet based cookbooks including Keep the Beat: Heart Healthy Recipes and Keep the Beat Recipes: Deliciously Healthy Dinners that provide plenty of meal ideas to help reduce blood pressure.
Limit alcohol consumption
Even moderate alcohol consumption can increase blood pressure. The American Heart Association recommends a maximum intake of two alcoholic beverages a day for men, and one for women. Men older than 65 should not have more than one drink a day.
The following counts as one drink:
- A 12-ounce (oz) bottle of beer
- 4 oz of wine
- 1.5 oz of 80-proof spirits
- 1 oz of 100-proof spirits
Your loved one’s healthcare provider can help them reduce consumption if they find it difficult to moderate their alcohol intake.
Quit smoking
Smoking causes a temporary increase in blood pressure and heightens the risk of atherosclerosis, a potentially serious condition where arteries become clogged with fatty substances. People who don’t smoke have a lower risk of hypertension, serious heart conditions, and other health issues. Ask your loved one’s doctor for tips to quit smoking and recommendations for smoking cessation medication and devices to help them overcome their addiction.
Reduce stress
Stress is one of the most common contributing factors to hypertension. Stress hormones adrenaline and cortisol make the heart beat faster and constrict blood vessels, raising blood pressure. Learning to manage stress can be highly beneficial for the blood pressure level. Some easy ways to relieve stress include getting enough sleep, listening to music, taking warm baths, practicing yoga and deep breeding, and taking long walks.
Manage body weight
Excess body weight can contribute to hypertension. Weight loss is usually followed by a fall in blood pressure because the heart no longer has to work so hard to pump blood in the body.
Research shows that reducing weight by just 3-5% can help lower the risk of health issues related to high blood pressure.
The body mass index (BMI)—the weight in relation to the height which is the estimate of total body fat—of less than 25 is the goal for maintaining optimal blood pressure. Your loved one’s doctor can help them determine specific weight goals suitable for their individual needs.
Monitor blood pressure
The American Heart Association (AHA) and American Society of Hypertension (ASH) recommend that the elderly with high blood pressure regularly monitor their readings at home in between doctor visits. Monitoring blood pressure can help patients track their treatment and get better control over their health. As a CDPAP caregiver, you can help your loved one monitor their blood pressure on a regular basis. If their pressure is over 120/80 mm Hg, they should talk to their primary care physician about what they can do to lower it.