An approach to Hypertension Treatment In The Elderly

In clinic today, I saw an 85 year old woman with Parkinson’s disease for follow-up of her high blood pressure. Her pressures have been difficult to control.

Today her BP is 170/80 with a heart rate of 62 bpm. She is taking an ACEi and a beta-blocker. Her daughter supervises the administration of her medications. She has no known history of heart disease or stroke, and mild renal disease which has been stable. Her EKG shows left ventricular hypertrophy.

We have tried to adjust her medications with alternative regimens but she has not tolerated them for various reasons.  For instance, on higher doses she felt dizzy when she stood up quickly. Amlodipine caused her legs to swell up.

She feels fine now, and wants to stop all of these changes. She wants to know if her present blood pressure is okay.

I ask myself—do I need to keep worrying about this? Is there any evidence that

• Controlling blood pressure in a woman her age has any benefit?
• What if she had more severe kidney disease, heart disease or a history of stroke?
• Is there a recommended medication regimen which is better tolerated by the elderly, especially those who are particularly vulnerable to orthostatic hypotension?

The following link includes diagnostic guidelines and treatment protocols.

Get back to me with your observations,

Dr L. T

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