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Evidence‐based care for the elderly with isolated systolic hypertension
Author(s) -
Wong Julia,
Wong Shirley
Publication year - 2005
Publication title -
nursing and health sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.563
H-Index - 47
eISSN - 1442-2018
pISSN - 1441-0745
DOI - 10.1111/j.1442-2018.2005.00212.x
Subject(s) - medicine , arterial stiffness , blood pressure , cardiology , epidemiology , vascular resistance , compliance (psychology) , intensive care medicine , psychology , social psychology
This paper reviews the epidemiology, pathophysiology and clinical significance of isolated systolic hypertension (ISH) in the elderly. Aging is associated with structural and functional changes in the arterial tree. Intimal thickening, migration of small muscle cells to the intima, medial fibrosis, and elastic fiber degeneration result in increased arterial stiffness and ISH. The augmented systemic vascular resistance in the elderly is mediated by increased arterial stiffness. Aging is correlated with overactivity of the sympathetic nervous system, reduced neuronal plasma norepinephrine uptake, and baroreceptor dysfunction. These functional changes all contribute to the development of ISH in elderly persons. Prospective and epidemiological studies have demonstrated that ISH is associated with coronary and cerebrovascular morbidity and mortality. There is good evidence indicating that lifestyle modifications such as weight reduction, increased physical activity, moderation of dietary sodium, and decreased alcohol intake, in combination with pharmacological therapy can effectively reduce blood pressure in elderly individuals with ISH. Primary health care providers can make significant contributions to the care of elderly persons with ISH. These contributions involve educating elderly people to control hypertension through lifestyle modification, monitoring the efficacy of antihypertensive therapy, and preventing complications associated with non‐compliance with therapeutic regimens.