INTRODUCTION
High blood pressure is one of the most common old age health issues and is one of the major risk factors for cardiovascular diseases. People over the age of 65 suffer mostly from isolated systolic hypertension with increased pulse pressure, resulting from loss of arterial elasticity. There are two types essential hypertension and secondary hypertension. There are a number of pathophysiological mechanisms of a permanent increase in BP in old age, similarly to younger age. In old age. Hypertension management is the single most effective tool available for reducing old-age disabilities. Many cardiovascular and kidney disorders and diabetes are more likely to rise with age related to hypertension.
DEFINATION
Hypertension is generally characterized by a chronic elevation above a certain threshold value of the systemic arterial pressure. However, growing evidence suggests that the risk of cardiovascular (CV) associated with blood pressure elevation (BP) above approximately systolic blood pressure (SBP) of 140 mmHg or greater, diastolic blood pressure (DBP) of 90 mmHg or greater. Hypertension is a progressive syndrome of the CV that results from diverse etiologies. Early syndrome markers are often present prior to experiencing BP elevation; thus, hypertension cannot be identified solely by distinct BP thresholds. Progression is closely correlated with heart and vascular functional and structural disorders that damage the heart, kidneys, brain, vasculature, and other organs and lead to premature morbidity and death. Stages of hypertension:- Staging a cycle of disease such as hypertension is an evaluation of the degree to which the disease has advanced at a given time.
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CAUSES
The cause of the hypertension is often unknown. In many cases it is the result of a condition underlying it. That is not due to any primary or critical hypertension disorder or illness. When an underlying disorder is causing blood to raise pressure, doctor call this secondary hypertension. Primary hypertension can be caused by many factors: 1) Blood plasma volume 2) Hormone activity in people who manage blood volume and pressure using medication 3) Factors on the environment, such as stress and lack of exercise (life style). Secondary hypertension has different causes and is another health condition that is complicated. Chronic kidney disease (CKD) is a common cause of high blood pressure because the kidneys do not filter out fluid any longer. This excess fluid leads to hypertension. Conditions that can lead to hypertension include: 1) diabetes, 2) due to kidney problems and nerve damage kidney disease 3) pheochromocytoma, a rare cancer of an adrenal gland Cushing syndrome that corticosteroid drugs can cause 4) congenital adrenal hyperplasia, 5) hyperthyroidism.
PATHOPHYSIOLOGY
There are a variety of pathophysiological pathways, close to the younger generation, for a lasting rise in BP in old age. Vascular changes play a crucial and causal role in old age, especially the large elastic-type central arteries, which usually have an elastic structure. Loss of this feature is common for older people with hypertension. Systolic blood pressure increases and diastolic blood pressure decreases or remains unchanged, i.e. changes in heart rate and frequency of single systolic hypertension. Morphological changes arise mostly in the vascular medium, where collagen continues to get older and elastin decreases with age. The volume factor is also added, in addition to a decreased vascular compliance. The aorta lengthens, has a larger diameter, and contains greater blood flow. The aorta's greater capacity contributes to its decreased ability to evacuate blood to the periphery. That systolic BP reflects a greater strain of the left ventricle-an increased afterload-and as a result, the functional and morphological changes take place. Left ventricular hypertrophy is observed more commonly in hypertensive elderly people than in other hypertensive groups; this is also a logical result of a long-term increase in blood pressure. Another common improvement is the decreased baroreflex sensitivity which can lead to orthostatic hypotension in elderly people. It is also one of the key mechanisms that cause increased variation of blood pressure of old age. Changes in renal function (loss of glomeruli, reduced blood flow) contribute to deterioration of salt balance and thus blood pressure is prone to sodium intake in old age. Another common shift is the reduction in plasma renin activity with age, with the decrease in renin activity being more pronounced in older hypertensive than in normotonics. And hypertension in old age is, therefore, usually weak. The decrease is thought to be attributable to hyaline degeneration of afferent arterioles in the kidney and decreased reactivity of β-adrenergic juxtaglomerular receptors. Another contributing factor to orthostatic hypotension is the decreased response of renin to upright position. [2]
SIGNS AND SYMPTOMS
Hypertensive Urgency: Can be completely asymptomatic (silent killer) and can be symptomatic as: severe headache, shortness of breath, epistaxis, and severe anxiety while signs: elevated BP on consecutive readings. Hypertensive Emergencies: Symptoms: as fatigue , loss of conscious , vision problems, chest pain, difficulty breathing, irregular heartbeat, blurry vision, Nausea, vomiting (cerebral edema) while signs : Retinal hemorrhages, exudates, or papilledema, renal involvement (malignant nephrosclerosis) with AKI, proteinuria, hematuria, cerebral edema :-seizures and coma , pulmonary edema, myocardial infarction, hemorrhagic Stroke, lacunar infarcts. [3]
INVESTIGATION
Patients with mild to moderate hypertension need only a clear schedule of investigations, particularly if first-degree relatives have a history of stroke or hypertension. Tests are important for profiling other cardiovascular risk factors and for detecting target organ damage with only minimal secondary hypertension screening. Careful history, physical examination, repeated measurements of blood pressure over months, and body mass index measurements, random cholesterol, routine blood chemistry and urinalysis using impregnated paper strips are all required. [4]
Pharmacological treatment in general
We should take into account the evidence gathered from broad trials when selecting a pharmacological treatment for a specific patient. In addition, account must be taken of the associated diseases of the patient and if they occur after any of the preparations evidence side effects .We currently have 5 classes of essential antihypertensive medications, for which it has been shown that their long-term administration contributes to a decrease in the occurrence of cardiovascular problems, in addition to a decrease in blood pressure. However, there are variations in the use of individual classes (and individual preparations) in the treatment of hypertension in old age.
COMPLICATIONS
Hypertension can cause long-term complications as atherosclerosis, in which plaque develops on blood walls vessels that narrowed them. This narrowing makes hypertension worse, since the heart needs to pump harder to get the blood circulating. Atherosclerosis linked to hypertension can lead to heart failure and heart attacks aneurysm. The hypertension creates a greater pressure load on the heart to induce the hypertrophy of the left ventricle, as the left ventricle is markedly thickened in this patient with severe hypertension that was untreated for many years. The myocardial fibers have undergone hypertrophy, or abnormal bulge in the wall of an artery that can burst kidney failure stroke amputation hypertensive retinopathies in the eye, which can lead to blindness. [8]
CONCLUSION
Hypertension is generally characterized by a chronic elevation above a certain threshold value of the systemic arterial pressure. It is a major cause of morbidity and mortality, and needs to be treated. It has 3 main stages, most of its causes related to life style and daily routine so life style modification should always be encouraged in all Hypertensive patients. There are a variety of pathophysiological pathways, close to the younger generation, for a lasting rise in BP in old age. Vascular changes play a crucial and causal role in old age, especially the large elastic-type central arteries, which usually have an elastic structure. Loss of this feature is common for older people with hypertension. Hypertension is called silent killer it could be asymptomatic. It can be investigated by home measurement by sphygmomanometer and laboratory tests. Hypertension management is the single most effective tool available for reducing old-age disabilities by non-pharmacological treatment and pharmacological one. Hypertension can cause long-term complications as atherosclerosis Regular blood pressure monitoring can help people avoid these more severe complications.
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