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Hypertension in the elderly – should we bother?

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Treating hypertension in elderly patients presents Treating hypertension in elderly patients presents ethical dilemmas, along with complex clinical challenges

The diagnosis and management of hypertension is an integral part of the general practice nurse (GPN) role. GPNs will often be involved in measuring blood pressure, identifying those with hypertension, ensuring that the appropriate pharmacological interventions are initiated and titrated and that patients with high blood pressure are supported to implement lifestyle changes which have been shown to reduce blood pressure. However, all of this can become more of a challenge to patient and clinician alike if the individual is elderly, frail or both. In this article, we discuss different approaches to the diagnosis and management of hypertension in the elderly when compared with other population groups and identify the challenges which make managing hypertension in this group a potentially complex problem.

Targeting treatment

In most people, a blood pressure (BP) of over 140/90mmHg would lead to consideration of treatment.1 However, the same guidelines from the National Institute for Health and Care Excellence (NICE) recommend using a higher cut off point of 150/90mmHg in people over 80. International guidelines, however, have recommended using this higher cut off point in a much younger age group, i.e. people aged 60 and above.2

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Wondering if the hypertension is certainly the cause of the increased cardiac events. Since it's almost universal past a certain age, maybe people are supposed to have higher bp as they age. And the cardio issues are due to other things. Everybody gets high bp. But not everybody has a stroke or heart attack.
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