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>>For Doctors >>December 2012

Hypertension Management
for the Elderly

The majority of older adults develop hypertension.1  In recent decades, there existed a view that hypertension must be an adaptive response to aging, and an age-based formula for appropriate systolic blood pressure (SBP) was often used: 100 + age.2,3   Today, we know that systolic blood pressure is a strong, independent  risk factor for cardiovascular events in all decades of life4,5 and that treatment of elevated SBP reduces cardiovascular risk among the elderly.6-9  The American College of Cardiology and the American Heart Association now recommend <140/90 mm Hg as the blood pressure goal for elderly patients with uncomplicated hypertension.10

Of course, management of prehypertension and hypertension among the elderly proves more challenging.  Older adults have a higher likelihood of being aware of their condition but also have the highest likelihood of having hypertension in an uncontrolled status.1  All expert and consensus recommendations include lifestyle modification as an important component of the management strategy (i.e. therapeutic diet, exercise, alcohol moderation, weight loss, and smoking cessation).  In fact, lifestyle modification alone may be sufficient as the entire treatment for milder cases of hypertension.11  Diet modification alone has been shown to reduce systolic blood pressure by up to 14 mm Hg.12,13   Regular physical activity such as a daily walk can reduce SBP by as much as 9 mm Hg.14-16   One study found that four hours of everyday activity around the home dropped participants’ blood pressure by one category (hypertensive to pre-hypertensive,  pre-hypertensive to normal).17  Despite this encouraging evidence, surveys reveal that hypertensive patients receive nutrition counseling at only 35% of office visits and exercise counseling at only 26% of visits.18   Authors suggest that low levels of patient adherence and difficulty verifying patient adherence decrease the motivation to provide ongoing lifestyle coaching in the primary care setting.19   When you have homebound patients with uncontrolled hypertension, newly diagnosed hypertension, newly diagnosed pre-hypertension, or a change in medications, call on Ideal Home Care to extend your healthcare teaching into the homes of your patients.  While inspiring weight loss and smoking cessation proves as challenging for us as it does for other healthcare practitioners, Ideal Home Care has particular success with improving adherence to medication regimen, therapeutic diet, exercise recommendations, and alcohol moderation. 

In cases of hypertension, remember Ideal Home Care for:



  1. Lloyd-Jones D, Adams R, Carnthon M, et al. Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009; 119: e21-181.
  2. Goodwin J. Embracing complexity: a consideration of hypertension in the very old. J Gerontol A Biol Sci Med Sci. 2003; 58: 653-8.
  3. Hajjar R. Commentary on “Embracing complexity: a consideration of hypertension in the very old.” J Gerontol A Biol Sci Med Sci. 2003; 58: 661-2.
  4. Stokes Ill J, Kannel W, Wolf P, et al. Blood pressure as a risk factor for cardiovascular disease: the Framingham Study – 30 years of follow-up. Hypertension. 1989; 12: I13-8.
  5. Lewington S, Clarke R, Quizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360: 1903-13.
  6. Amery A, De Schaepdryver A. The European Working Party on High Blood Pressure in the Elderly. Am J Med. 1991; 90: 1S-4S.
  7. Coope J, Warrender T. Randomised trial of treatment of hypertension in elderly patients in primary care. Br Med J (Blin Res Ed). 1986; 293: 1145-51.
  8. Medical Research Council trial of treatment of hypertension in older adults: principal results – MRC Working Party. BMJ. 1992; 304: 405-12.
  9. Dahlof B, Lindholm L, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP+Hypertension). Lancet. 1991; 338-1281-5.
  10. Aronow W, Fleg J, Pepine C, et al. ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly. J Am Coll Cardiol. 2011; 57 (20): 2037-2114.
  11. Whelton P, He J, Appel L, et al. Primary prevention of hypertension: clinical and public health advisory from the national High Blood Pressure Education Program. JAMA. 2002; 288: 1882-8.
  12. Sacks R, Svetkey L, Vollmer W, et al. DASH-Sodium Collaborative Research Group Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. N Engl J Med. 2001; 344: 3-10.
  13. Vollmer W, Sacks F, Ard J, et al. Effects of diet and sodium intake on blood pressure: subgroup analysis of the DASH-sodium trial. Ann Intern Med. 2001; 135: 1019-28.
  14. Whelton S, Chin A, Xin X, et al. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002; 136: 493-503.
  15. Hagberg J, Montain S, Martin III W, et al. Effect of exercise training in 60 to 69-year-old persons with essential hypertension. Am J Cardiol. 1989; 64: 348-53.
  16. Kelley G, Kelley K. Progressive resistance exercise and resting blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2000; 35: 838-43.
  17. Stewart S, Pearson S, Horowitz JD. Effects of a home-based intervention among patients with congestive heart failure discharged from acute hospital care. Arch Intern Med. 1998;158:1067-1072.
  18. Mellen P, Palla S, Golf Jr. D, et al. Prevalence of nutrition and exercise counseling for patients with hypertension: United States, 1999 to 2000. J Gen Intern Med. 2004; 19: 917-24.
  19. Volpe M, Tocci G.  Challenging hypertension: how to diagnose and treat resistant HTN: epidemiology & clinical relevance of resistant hypertension. Expert Rev Cardiovasc Ther. 2010; 8(6): 811-820.
  20. McCarron D, Reusser M. Cardiovascular Risk Reduction Dietary Intervention Trial. Drug Benefit Trends. 2000; 12(5): 42-48.
  21. U.S. Preventive Services Task Force. Behavioral counseling in primary care to promote a healthy diet: recommendations and rationale. Rockville MD: Agency for Healthcare Research and Quality, 2002.
  22. Costa L, Poe S. Challenges in posthospital care: nurses as coaches for medication management. J Nurs Care Qual. 2011; 26 (3): 243-251.





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