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Results from cross-sectional studies have shown that blood pressure, particularly systolic blood pressure (SBP), increases with increasing age. No age adjustment is made in setting the threshold value that defines high blood pressure. The classification of blood pressure outlined by the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI), shown in Table 40.1, is the same for all adults irrespective of age. There were several minor modifications made in the JNC-VI revision of blood pressure classification that have major significance with respect to geriatric hypertension. The former category of isolated systolic hypertension [i.e., SBP > 160 mmHg and diastolic blood pressure (DBP) < 90 mmHg] was removed. In addition, the conjunction linking the systolic and diastolic blood pressure columns that define each stage was changed from "and" to "or." As a consequence of this new approach to classification and because isolated diastolic hypertension is so uncommon in older individuals, the correct categorization of blood pressure among those above age 60 may be made by using the level of SBP alone in 99% of cases. Thus, the SBP level matters for the purposes of classification. Finally, as is discussed, treatment recommendations are stratified, based in large part on the classification strategy shown ... more » »
Approximately 5% of patients with hypertension have specific causes (Table 11-3). The history, examination, and routine laboratory tests may identify such patients. In particular, patients in whom hypertension develops at an early age, those who first exhibit hypertension when over age 50 years, or those previously well controlled who become refractory to treatment are more likely to have secondary hypertension. Causes include renal disease, genetic causes, renal vascular hypertension, primary hyperaldosteronism, Cushing's syndrome, pheochromocytoma, coarctation of the aorta (uncommon), hypertension associated with pregnancy, estrogen use, as well as other causes (eg, hypercalcemia and medications) ... more » »
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