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HYPERTENSION IN THE ELDERLY

Hasyim Kasim

Prof DR.Dr.Syakib Bakri

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ELDERLY

> 65 YEARS

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BLOOD PRESSURE CLASSIFICATION

JNC 6 – 1997 JNC 7 - 2003

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PhysicalPhysical

ExaminationExaminationAccurate measurement of blood pressure

General appearance : distribution of body fat, skin lesions,

muscle strength, alertness

FunduscopyNeck : palpation and auscultation of carotids, thyroid

Heart : size, rhythm, sounds

Lungs : rhonchi, rales

Abdomen : renal masses, bruits over aorta or renal arteries,

femoral pulses, waist circumference

Extremities : peripheral pulses, edema

Neurologic assessment, including cognitive function

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Blood Pressure MeasurementBlood Pressure Measurement

• Patients should be seated with back supported and arm bared and

supported.

• Patients should refrain from smoking or ingesting caffeine for 30

minutes prior to measurement.

• Measurement should begin after at least 5 minutes of rest.

• Appropriate cuff size and calibrated equipment should be used.

• Both SBP and DBP should be recorded.

• Two or more readings should be averaged.

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POPULATION : Notice the increase in the

elderly population as the baby – boomers age

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PERCENT ELDERLY BY AGE 2000 – 2030

IN AMERICA ( U.S. CENCUS 2000 )

0

5

10

15

20

25

2000 2015 2030

> 65

> 75

> 80

21,9% 25,2% 35,1%

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INDONESIAN ELDERLY POPULATION

( > 65 YEARS )

Ind. Cencus 1971, 1980, 1990, 1995 and 2000

0

1

23

4

5

67

8

9

10

1971 1980 1990 1995 2000

>65

years

 Biro Pusat Statistik 

 Indonesia

2,51%3,25%

3,88%4,25%

4,75%

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Aging is NOT a disease

Aging is a universal process.

Many elderly have arthritis, ordementia, or hypertension

But not everyone gets the samedisease

Disease is not a necessary part of aging

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Principal Effects of 

 Aging on the Cardiovascular System

• Increased arterial stiffness

• Increased myocardial stiffness

• Impaired β-adrenergic responsiveness

• Impaired endothelial function• Reduced sinus node function

• Decreased baroreceptor responsiveness

• Net effect: Marked reduction in CV

  reserve

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Systolic BP rises continuously with age

Diastolic BP rises continuously until age 60-70years

It falls thereafter as a consequence of increased arterial stiffness

Systolic HypertensionPulse pressure increases continuously with

age

Smulyan H, Safar ME. Ann Intern Med . 2000;132:233-237.