Being a CDS caregiver for someone who has high blood pressure can require careful management of their diet, activity levels, and medication needs on a daily basis. Without careful maintenance of these factors, someone with hypertension can suffer major health issues in a short period of time. Hypertension can be easy to manage or hard to manage depending on the severity of the condition and the reasons that a patient is dealing with it.
If you are not sure about the best ways to define or care for hypertension, this article will explain what hypertension is and how it can be managed. These instructions are particularly relevant for elderly people who are struggling with hypertension and management of this health concern.
What is Hypertension?
Hypertension, also known as high blood pressure, is a common condition that is caused by the higher-than-normal force of the blood against artery walls. This increased pressure against the walls of your arteries can lead to heart disease as well as other health concerns that can limit a patient’s quality of life.
When measuring blood pressure, the top number that is considered is the pressure in the arteries as the heartbeats. The bottom number is the pressure in the arteries between beats. The combined total is your overall blood pressure number.
Normal blood pressure is 120/80 or less. Elevated blood pressure is greater than 120/129 or greater than 80 mmHg. Hypertension has stages to help define the severity of the condition.
Stage 1 Hypertension is 130/139 mmHg with a BP of 80-89. Stage 2 Hypertension is 140 mmHg or more with diastolic BP of 90 mmHg or more. You can have slightly elevated blood pressure without being considered either stage one or stage two, but over time this condition will get worse and lead to actual hypertension down the road.
Why is Treating Hypertension so Important?
Leaving hypertension untreated can lead to many serious health conditions. Cardiovascular disease is progressive and it will only get worse and not better over time. Hypertension can lead to lots of other health concerns and conditions, particularly in the elderly.
The following conditions are related to untreated hypertension:
· Heart attack
· Stroke
· Aneurysm
· Heart failure
· Narrow and weakened blood vessels in the kidneys
· Torn or narrowed blood vessels in the eyes
· Metabolic syndrome
· Trouble with memory
· Cognitive issues
· Dementia
· Blindness
· Peripheral artery disease
· Angina
· Sexual dysfunction
All of these many side effects can impact the elderly just like they impact younger people with hypertension. This is a serious health concern that some people do not take seriously enough.
What is Elderly Hypertension?
The elderly age group in medical terms is between 65 and 79 years of age. Very elderly people are considered to be those 80 years and older. There are some normal ranges of expected blood pressure that are associated with people in these age groups due to statistics about the changes to the body that can be expected at these ages. This does not mean that high blood pressure is normal for the elderly in these groups, however.
Normal Blood Pressure For the Elderly
For these groups, the blood pressure that you should be looking for is 130/80. This number is slightly different than what is expected for younger people due to the natural age-related stiffening of the major arteries. The range that is commonly accepted for this age group is anywhere from 130/80 to 150/90.
Anything that is over these limits is an indication that something is wrong and that more attention is required. Most elderly people cannot change a lot of the other factors of their diet and other living conditions easily, but they can manage their condition with medication quite readily in most cases.
Pharmacotherapy to Treat Hypertension
Helping an elderly person that is in your care can be difficult if they do not think that they have an issue. Some elderly people are not very open to treatment for any kind of health concern, particularly if they have other health challenges.
The nice thing about pharmaceutical controls for hypertension is that it is an easy way to manage blood pressure that can be done by taking a pill at the same time of day each day. Some elderly people will resist or not understand the need for dietary changes and other life changes to manage their hypertension, so medication management can be a big help.
If you think that the person that you are caring for qualifies for hypertension treatment, you can ask their doctor. This is one of the privileges of being a caregiver and you can ask questions about the use of medications to manage hypertension for your patient. You will also likely have to be vigilant about possible side effects as well as the success of the medication at controlling hypertension after the medication has been taken for a while.
Treating hypertension with medications involves taking one of several common hypertension medications at a low introductory dose to see how the medication improves the person’s blood pressure readings. The lower the dose, the easier it is to manage the medication without side effects and with good results. These pills need to be taken at the same time each day to prevent issues with blood pressure leaping up or plummeting down as a result of the medication getting out of the system.
When a person first begins to take medication for their blood pressure, they might experience some symptoms related to their body getting used to the new medication. This might be shortness of breath or dizziness as well as tiredness. If these symptoms get worse, you will need to take your patient in to see a doctor and to have their medication dose adjusted.
Kinds of Medications That Might be Prescribed for Hypertension
· Diuretics
These are also called water pills. They are medications that help the kidneys to eliminate sodium and water from the body. They are often the first line of defense for the treatment of hypertension. There are many of these drugs on the market. They are also sometimes used for the treatment of heart conditions.
These medications can cause increased urination as well as reduced potassium levels. You could possibly be given a potassium supplement to help your patient with this reduction of potassium levels.
· ACE Inhibitors (Angiotensin-Converting Enzyme)
These are also commonly used for treatment of hypertension. They help to relax the blood vessels by blocking the formation of natural chemicals that narrow the blood vessels. Common drugs in this class are Prinivil, Zestril, Lotensin, captopril, and more.
· ARBs (Angiotensin-Converting Blockers)
These medications are effective because they block the action and not the formation of the natural chemicals that narrow blood vessels. These medications might be named Atacand, Cozaar and there are other medications that do the same thing that goes by other names.
· Calcium Channel Blockers
These medications help relax the blood vessels as well. Some can also slow the heart rate. Calcium channel blockers work best in those of African heritage and are the choice for them in place of ACE inhibitors. These drugs go by names like Cardizem, Tiazac, and Norvasc. There are others on the list as well. These medications require that those who take them do not ingest grapefruit as it can cause dangerous interactions with the medication.
· Alpha Blockers
These medications can reduce the nerve signals to blood vessels. This will make sure that natural chemicals will not cause the blood vessels to narrow further. Cardura, Prazosin, and other medications are on this list.
· Alpha-Beta Blockers
These also block nerve signals to blood vessels and slow the heartbeat down. This means that the amount of blood pumping through the blood vessels is reduced. Common names for these medications are acebutolol, atenolol, and some others.
· Beta Blockers
These are commonly used to treat high blood pressure and can also be used to treat heart conditions. These medications reduce the workload on the heart and widens the blood vessels. This can help the heart to beat more slowly and with less force. These are not always recommended to be taken alone and are often combined with other medications that treat hypertension. Common names for these medications are acebutolol, atenolol, and some others.
· Renin Inhibitors
These medications reduce the production of renin which is an enzyme that is made by the kidneys. These chemical processes increase blood pressure. These medications cannot be taken with ACE inhibitors or ARBs due to the risk of stroke.
· Aldosterone Antagonists
These drugs are also considered to be diuretics. They block the effects of the natural chemical that can lead to salt and fluid buildup which can lead to high blood pressure. These medications can treat heart conditions as well as hypertension.
· Vasodilators
These medications work directly on the muscles and walls of the arteries. They prevent the muscles from tightening up and causing the arteries to narrow.
· Central-Acting Agents
These medications prevent your brain from telling the nervous system to increase the heart rate and thereby narrow the blood vessels. These medications are not used in every case due to side effects, but they can be quite effective for some patients.
Tracking Side Effects
This is a place where a caregiver has to take the reins on their patient’s needs. Many elderly people are not willing or able to take the time to track symptoms related to their hypertension or the management of it. You will need to help with this process to make sure that the medication that is being given is given at the right dose and having the right effect.
Track symptoms and side effects like a dry cough, rash, dizziness, fatigue, and headaches. You might also need to work with the doctor that prescribed the medication to look at blood work and make sure that creatinine and potassium levels in your patient are not affected.
In some cases, a medication can cause the blood pressure to get too low, which can lead to a state that is like sleep, dizziness, or extreme fatigue as well as blurred vision, cold and clammy skin, and fainting. Your elderly patient might not be sure what is causing these symptoms, so you need to help track their appearance in relation to doses of the medication when they are taken.
It can help to create a chart that logs the time of the side effect as well as the duration that it is experienced and the severity of the side effect. Timing of symptoms can help relate them to medication that has been taken and you will be able to see if the symptoms are getting worse over time with the use of the chart.
Other Ways to Lower Blood Pressure for the Elderly
There are other ways that you can help your elderly patient to take care of their hypertension. These adjustments can have a big impact and might help support taking a reduced dose of hypertension medications, or being able to stop taking them altogether.
· Weight Loss
Being at a healthy weight can greatly improve hypertension. Make sure that your patient is able to exercise some and that they are able to eat a healthier diet if they need to lose weight. Some patients might not be able to make the necessary adjustments to do so, but it can be a big help if they are able to make these concessions to their health.
· Exercise Daily
If possible, everyone should exercise daily. Being sedentary can cause hypertension to be much worse. Even exercising for about an hour a week lightly can make a big difference in blood pressure management and reduce the risk of other issues like blood clots and heart disease.
· Dietary Changes
Reducing the amount of salt in the diet and making sure that your patient is eating a diet that is rich in whole grains, low-fat dairy items, fruits, and vegetables can make a big difference in hypertension management. Sodium is linked directly to blood pressure, so reducing sodium significantly can make a huge difference in hypertension for people of all ages.
· Drinking Less Alcohol
Alcohol is a big no-no when trying to manage blood pressure effectively. Alcohol should be limited to no more than one drink a day for women and two a day for men. This can make a big difference in the treatment of many health concerns, not just hypertension.
· Quit Smoking
It is no secret now that smoking is bad for your health. Some elderly people hate the thought of quitting smoking, but this is always the best choice for them to make, no matter what kinds of health concerns they might be attending to.
· Getting Good Sleep
Getting enough sleep at night can be very important for controlling hypertension. This might be hard to control for some elderly people who are on medications that cause issues with sleep. You may not be able to completely improve their sleep experience, but you can sometimes find methods that will at least improve their ability to sleep.
· Manage Stress
Helping your elderly patient to relax and manage stress is important for their overall health. Stress can be a major factor in high blood pressure for people of all ages, so stress management can be very effective at managing hypertension.
What if the Medication Causes Very Low Blood Pressure?
Sometimes the switch to medication can cause very low blood pressure as a side effect. Some people are very sensitive to these medications and can have these side effects. Incorrect dosage can cause this as well.
Signs of very low blood pressure can be a lot like those of high blood pressure, but the primary signs are nausea, dehydration, cold and clammy skin, blurry vision, and fainting. These are serious symptoms and you will need to take action immediately to make sure that your patient gets medical attention right away.
What if My Patient Does Not Want to Take Medication?
It can be hard to treat someone who does not want to take medications. Even if they know that medications are needed to maintain their health, some people can be very stubborn about taking them. This can be one of the biggest challenges for caregivers of the elderly.
Always remember that you cannot force your patient to take their medications, even if it is tempting to try and coerce them into taking them through some level of force. This might seem necessary for the overall maintenance of their health, but it is not allowed. There are better ways to make sure that your patient takes their meds in any case.
· Have the Patient Evaluated
This evaluation can make sure that a doctor gets involved to see if cognitive conditions or depression might be leading to the refusal to take medications. It can be much easier to take care of someone who is feeling happy and positive about their overall care than it would be to take care of someone depressed and upset or scared and confused. A doctor can help you to manage other health concerns much more effectively if your patient is not feeling upset and scared on a daily basis.
· Consider Mental Health Care
Sometimes emotional struggles can lead to a patient being unwilling to take their medications. You can help your patient to feel more positive and cared for by making sure that they get the mental health support that they need. You might find that the medications are not actually the issue and that your patient needs to have someone to talk to about their fears about their health concerns or getting older. There are many struggles that older people have a hard time naming or bringing to light and sometimes a mental health professional can make a big difference for the treatment of these concerns.
· Discuss Things With The Patient
If your patient is scared or feels like they have no choice in their daily healthcare regimen you can try talking to them about their medication and why they need to take it. Sometimes elderly people miss out on a lot of details about their healthcare due to hearing issues and cognitive problems. They might also feel like everyone is talking about them all the time and not to them.
This is where having a discussion with them one-on-one can really help in some cases. They might only be protesting taking medication because they are scared about what is going on around them and feel like no one has told them why they have to take it. You can make a big difference in their confidence in the treatment protocol by talking to them about why the medication needs to be taken and what it is doing for their health.
· Set Gentle Reminders
If your patient handles being reminded to take their medications through the use of an alarm rather than a verbal request, you can cater to this need. There are many ways to make sure that neither of you forget they need to take the medications, and you can resist friction by making the process about setting reminders and not about bossing them around.
Some older people are still very independent overall and do not like younger people telling them what to do. You can reduce friction related to medication timing by making it more about them remembering to take their medications than about your bossing them around and making them take them. These nuances might seem small, but they can make a big difference when your patient is not willing to take their meds.
Caring for an Elderly Person With Hypertension Requires Attention to Detail
Anytime you are taking care of an elderly person with hypertension, you will need to make sure that their medications are taken on time and that their diet and lifestyle are correct for their overall health. Making sure that you track side effects and changes in the behavior of overall health can also make a big difference in the success of their treatment.
Advocating and caring for an elderly person with hypertension includes making sure that you know that they are managing their high blood pressure and not ignoring it.
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