Changes in the cardiovascular system in the elderly include increased cardiac mass, left ventricular hypertrophy, and the ability of the heart is reduced due to disruptive changes in the connective tissue. Oxygen consumption at maximum level is reduced, so that decreased lung capacity. Useful exercise to improve VO2 maximum, reducing blood pressure, and weight.
Called the silent killer because one half of patients with high blood pressure are not aware of the condition of his health. Hypertension in the elderly is defined by systolic pressure above 160 mmHg or a diastolic pressure above 90 mmHg.
Hypertension is defined as persistent blood pressure where the systolic pressure above 140 mmHg and diastolic above 90 mmHg. In the elderly population, hypertension is defined as systolic pressure of 160 mmHg and a diastolic pressure of 90 mmHg.
Hypertension in the elderly distinguished by:
- Hypertension where systolic pressure equal to or greater than 140 mmHg and / or diastolic pressure equal to or greater than 90 mmHg.
- Isolated systolic hypertension where systolic pressure greater than 160 mmHg and diastolic blood pressure lower than 90 mmHg.
Classification based on the cause of hypertension can be divided into two major categories, namely:
- Essential hypertension (primary hypertension) is hypertension of unknown cause.
- Secondary hypertension is hypertension caused by other diseases.
Cause of hypertension in the elderly is the occurrence of changes in:
- Decreased elasticity of the aortic wall.
- Heart valves to thicken and become stiffer.
- Heart's ability to pump blood decreased 1% per year after age 20 years, the heart's ability to pump blood causes decreased contraction and decreases the volume.
- Loss of elasticity of blood vessels. This happens due to lack of efficacy for peripheral vascular oxygenation.
- Increased peripheral vascular resistance.
Signs and symptoms of hypertension can be divided into:
1. No symptoms
There are no specific symptoms that can be associated with increased blood pressure, in addition to the determination of arterial pressure by the examining physician. This means that arterial hypertension will never diagnosed when arterial pressure was not measured.
2. Common symptoms
It is often said that the common symptoms that accompany hypertension include headache and fatigue. In fact this is a common phenomenon that the majority of patients who seek medical attention.
According Rokhaeni (2001), some of the clinical manifestations of patients suffering from hypertension are: complaining of headaches, dizziness, weakness, fatigue, shortness of breath, anxiety, nausea, vomiting, epistaxis, decreased consciousness.
Examination Support
1. Hemoglobin / hematocrit
To examine the relationship of the cells to the volume of fluid (viscosity) and may indicate risk factors such as hypercoagulability, anemia.
2. BUN
Provide information about renal perfusion Hyperglycemia Glucose (diabetes mellitus is the originator of hypertension) can be caused by an increase in catecholamines (increase hypertension)
3. Serum potassium
Hypokalemia may indicate a presence of primary aldosterone (causes) or a side effect of diuretic therapy.
4. Serum calcium
Increased serum calcium levels can cause hypertension
5. Serum cholesterol and triglycerides
Elevated levels may indicate the originator for / of the atheromatous plaque formation (cardiovascular effects)
6. Thyroid examination
Hyperthyroidism can cause vasoconstriction and hypertension
7. Aldosterone levels urine / serum
To assess primary aldosteronism (cause)
8. Urinalisa
Blood, protein, glucose, and renal dysfunction signaled or the presence of diabetes.
9. Uric acid
Hyperuricemia has been the implications of the risk factors of hypertension
10. Urinary steroid
The increase may indicate hiperadrenalisme
11. IVP
Can identify the causes of hypertension such as renal parenchymal disease, kidney stones / ureter
12. Photos chest
Obstruction showed calcification in the valve area, cardiac enlargement
13. CT scan
To assess cerebral tumor, encephalopathy
14. ECG
May show an enlarged heart, patterns strain, conduction disorders, elevation of the P wave is one early sign of hypertensive heart disease.
Hypertension management aims to prevent morbidity and mortality from cardiovascular complications related to the achievement and maintenance of blood pressure below 140/90 mmHg.
Therapy without medication is used as a measure for mild hypertension and as a supportive measure in moderate and severe hypertension. Without drug therapy include:
1. Diet
Diet is recommended for patients with hypertension:
a. Moderate salt restriction of 10 g / hr to 5 g / hr
b. A diet low in cholesterol and low in saturated fatty acids
c. Weight loss
d. Decrease in ethanol intake
e. Stop smoking
2. Physical Exercise
Physical exercise or sports are organized and directed that recommended for patients with hypertension is a sport that has four principles: Various sports are isotonic and dynamic such as running, jogging, cycling, swimming and others.
Good exercise intensity between 60-80% of aerobic capacity or 72-87% of the maximum pulse rate, called the training zone. Exercise duration ranged from 20-25 minutes in the zone should exercise frequency exercise 3 x per week and at least a good 5 x per week
3. Psychological Education
Provision of psychological education for hypertensive patients include:
a. Biofeedback techniques
Biofeedback is a technique that is used to indicate the subject of the signs of the state of the body that is consciously by the subject is not considered normal.
Application of biofeedback is mainly used to overcome somatic disorders such as headache and migraine, also for psychological disorders such as anxiety and tension.
b. Relaxation techniques
Relaxation is a procedure or technique that aims to reduce tension or anxiety, a way to train people to be able to learn to make the muscles in the body become relaxed
c. Health Education (Extension)
The purpose of health education is to increase patients' knowledge about hypertension and its management so that patients can sustain life and prevent further complications.
