Hypertension in the elderly

Table 1 Classification of blood pressure for adults according to JNC-7

Classification	SBP (mmHg)	DBP (mmHg)
Normal	≤ 120	And ≤ 80
Prehypertension	120-139	Or 80-89
Stage 1 hypertension	140-159	Or 90-99
Stage 2 hypertension	≥ 160	Or ≥ 100

SBP: Systolic blood pressure; DBP: Diastolic blood pressure.

Table 2 Classification of blood pressure for adults according to ESH/ESC 2007

Classification	SBP (mmHg)	DBP (mmHg)
Οptimal	≤ 120	And ≤ 80
Normal	120-129	80-84
High normal	130-139	85-89
Hypertension
Grade 1 (mild)	140-159	90-99
Grade 2 (moderate)	160-179	100-109
Grade 3 (severe)	≥ 180	≥ 100
Isolated systolic hypertension	≥ 140	≤ 90

SBP: Systolic blood pressure; DBP: Diastolic blood pressure.

Table 3 Causes of secondary hypertension

Hyperaldosteronism

Cushing syndrome

Coarctation of the aorta

Renovascular stenosis

Endocrine disorders (thyroid, parathyroid abnormalities)

Obstructive sleep apnea

Drugs (nonsteroidal antiinflammatory drugs, alcohol, estrogen)

Chronic kidney disease

Pheochromocytoma

Table 4 Causes of resistant hypertension

False positive or pseudoresistance

Incorrect technique in measuring blood pressure

Pseudohypertension

Lack of adherence to life style modifications

Lack of patient adherence to antihypertensive therapy

Suboptimal therapy

True resistant hypertension

Sleep apnea

Hypertension related to secondary etiology

Table 5 Therapeutic strategies

Non-pharmacological strategy

Weight reduction

Dietary sodium reduction

Physical activity

Moderate alcohol consumption

Dash diet

Pharmacological strategy

Main Pharmacological agents

Thiazide diuretic: inhibiting reabsorption of sodium (Na+) and chloride (Cl-) ions from the distal convoluted tubules in the kidneys →→↓ BP, ↓ stroke, ↓ CV mortality

ACEIs: block the conversion of angiotensin I to angiotensin II →→↓ SVR, ↓ BP, ↓ mortality in patients with MI and left ventricular dysfunction, ↓ progression of diabetic renal disease

ARBs: direct blockage of angiotensin II receptors →→ vasodilation (↓SVR), ↓ secretion of vasopressin, ↓ aldosterone, ↓ BP, ↓ stroke. Generally, in patients who cannot tolerate ACEs

Calcium antagonists: disrupts the movement of calcium through calcium channels in cardiac muscle and peripheral arteries →→ vasodilation (↓ SVR), ↓ BP, ↓ CV complications in elderly patients with ISH

β blockers: ↓ heart rate, ↓ cardiac contractility, ↓ cardiac output, inhibit renin release, ↑ nitric oxide, ↓ vasomotor tone →→↓ BP

Other agents: direct renin inhibitors, aldosterone receptor antagonists, centrally acting agents, direct vasodilators, α-adrenergic blocking agents

Combination therapy

ACEIs or ARBs/Diuretic

ACEIs or ARBs/Calcium antagonist (especially in patients with high CV risk)

CV: Cardiovascular; BP: Blood pressure; ACEIs: Angiotensin converting enzyme inhibitors; ARBs: Angiotensin receptor blockers; SVR: Systemic vascular resistance.