CC July 2017 Hypertension in the Elderly

echoecho's version from 2017-11-01 23:41


Question Answer
HTN is a common, treatable disease seen in primary care, and ___ to ___% of pts over 60-65 years of age have this diagnosis?60; 80
Untreated HTN contributes to what 4 conditions?1) CVA 2) MI 3) renal disease 4) death
Eighth Joint National Committee on Prevention, Detection, Evaluation, and treatment of high blood pressure (JNC 8) to update recommendations and goals for treating HTN in patients ____ or older?60
*** The recommendation targets BP for patients and older at < ___/ ___?150; 90
Patients 30-59 y.o. have a BP target of < ____ / ____?140/90
What modifications continue to be the foundation of HTN management; indeed, these changes may be sufficient for initial BP control in many ____ patients?elderly
What are the dietary recommendations?1) limiting salt intake to 2400 mg per day 2) getting regular exercise 3) maintaining health weight
alcohol intake should be limited to ___- drink per day for women and ___ drinks per day for men?1; 2
Caffeine should be limited to no more than ___ drinks per day?4
All tobacco users should be strongly encouraged to ____?quit
There is strong evidence linking what medical condition to elevated BP?OSA
Obese patients are especially at risk and be ____? screened
Question Answer
Medication dosing should be approached with caution, particularly in older, more frail patients, using doses as what?as low as half of those used with younger patients
List the side effects more common in the elderly?orthostatic hypotension
Lowering BP over a longer time (weeks or months) may be appropriate to avoid what?central nervous system ischemic symptoms from blood flow that is reduced too quickly
Once med therapy is initiated, what type of monitoring is recommended?close monitoring
The recommended drug classes for the general nonblack population include?1) thiazide diuretics 2) angiotension-converting enzyme inhibitors 3) angiotension receptor blockers 4) calcium channel blockers
For the general black population, including patients with diabetes, therapy should be either what med?either a thiazide-type diuretic or CCB
*** The JNC 8 results found that all the drug classes had equal outcomes related to overall mortality, cardiovascular and cerebrovascular events and kidney disease; however, _____ diuretics had a superior outcome in improving heart failure outcomes. These diuretics were more effective than the other classes as initial therapy?thiazides
Med disease should be carefully increased or a second agent from another class if goals have not been met in a reasonable period of time -- a month for younger patients; however JNC8 and others recommendations do not specify how ____ to increase intensity of therapy among the elderly?quickly
Previous studies have found that a single-agent treatment with alpha blockers such as _____ was associated with worse cardiovascular outcomes compared to initial diuretic therapy?doxazosin (Cardura)
Alpha blockers have additional adverse side effects including what in the elderly?1) orthostatic hypotension 2)falls
The new guidelines dropped beta blockers as initial therapy due to what?increased risk of cardiovascular events (mainly stroke) when used as initial therapy
*** SUMMARY = HTN is a common problem in the elderly, with ___ to ___% of patients over 60-65 years of age having this dx?60; 80
*** SUMMARY = Lifestyle modifications that are important HTN management tools are?1) dietary salt restriction 2) moderating alcohol intake 3) getting regular exercise 4) weight control
*** SUMMARY = approaches to med therapy should be made with care. Elderly often required ____ doses than younger patients and may more frequently suffer side effects such as what?1) lower 2) orthostatic hypotension