Managing Hypertension in Elders

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Hypertension or high blood can lead to several complications for senior citizens. Dr Priyanka Rohatgi on how to manage hypertension in elders. 

Hypertension is defined as a repeatedly elevated blood pressure. In India, the prevalence of hypertension ranges from 20-40% in urban adults and 12-17% among rural adults, according to studies. The number of people with hypertension is projected to increase from 118 million in 2000 to 214 million in 2025, with nearly equal numbers of men and women. Given the lack of awareness, we need to know how to manage hypertension in elders as it could lead to several complications.

The most common form of hypertension is known as Essential Hypertension or Idiopathic Hypertension. Some times, high blood pressure may be due to disease of kidney, hormonal glands, mechanical obstruction of blood flow, neurogenic, pregnancy induced or due to medication. These are known as Secondary Hypertension because this hypertension is secondary due to some other cause. This type of Hypertension or High blood pressure can be cured if we can treat the cause. However, in Primary Hypertension, medical experts can only control, not cure. Since Hypertension is a lifestyle disease, managing hypertension in elders can be achieved by making minor changes in one’s lifestyle including diet and sometimes medication. Weight loss is an important factor. Obesity and hypertension together will increase the chance of developing other cardiovascular complications and if the senior citizen has diabetes, the risk will multiply. It is also a major risk factor for heart diseases, kidney failure and strokes.

 

Checking blood pressure Photograph: Wikimedia Commons

Checking blood pressure
Photograph: Wikimedia Commons

Risk Factors for Hypertension

* Genetic factors or hereditary

* Diet – Excessive energy intake leads to obesity and tends to increase blood pressure.

* Psychological factors – Stress and strain also play a major role for high blood pressure.

* Other factors – Renal, hormonal or any other disease can also cause hypertension.

* Mechanical obstruction to blood flow – arteriosclerosis

* Drugs – contraceptive pills, steroids

Stress Management

Management for Hypertension includes meditation, exercise, diet and drugs. Small change in life style, like avoiding extra commitment, reduction in working hours, adequate rest and sleep is important in control of hypertension.

Meditation

Relaxation techniques like yoga, transcendental meditation or any kinds of meditation are found to be very useful methods to control high blood pressure. Biofeedback (a technique you can use to learn to control your bodily functions) has also shown useful result in controlling hypertension.

Exercise

Regular exercise will help to lower the blood pressure. Start with mild exercise like walking and slowly increase your intensity and duration. Rigorous exercise is a risk of having heart attack. Consult your doctor before starting the exercise program. Moderate exercise like walking or jogging helps to reduce the diastolic pressure by about 15 – 20 mm of Hg.

Diabetic Management through food

Tomatoes are high in potassium. Photograph courtesy: Softeis, Wikimedia Commons

Tomatoes are high in potassium and good for you.
Photograph courtesy: Softeis/Wikimedia Commons

 

Calories

If the person is obese, the calories has to be restricted. Otherwise, normal individuals need the daily-recommended calorie according to the age, sex and physical activity.

Protein

In severe hypertension, the protein has to be restricted to 20 gm/day where as the mild and moderate hypertensive can have 1 gm/kg body weight. For example if the person is 60kg then he can have 60 gms of protein/day.

 

Fats

It is advisable to reduce the fat consumption since hypertension has greater risk of arteriosclerosis or the thickening and loss of elasticity of the walls of arteries, leading to heart complications. It is better to avoid high intake of animal fat or hydrogenated oils, which contain saturated fatty acids. The cholesterol rich foods such as liver, meat, organ meat, egg yolk, lobster, crab and prawns should be minimised in the diet. The dietary fats should consist of vegetable oil like corn oil, olive oil and sunflower oil.

Minerals And Vitamins

Celery is also beneficial for those with hypertension. Photograph: Wikimedia Commons

Celery is also beneficial for those with hypertension.
Photograph: Wikimedia Commons

A low fat, low sodium and high potassium diet will help to lower high blood pressure. Moderate sodium restriction of 2-3 gm per day decreases diastolic blood pressure and enhances the blood pressure lowering effect of diuretic therapy. Potassium intake should be increased. Food sources of potassium should be increased to patients who are on diuretics. For example apricots, tomato, chickoo, watermelon, banana, leafy vegetables, bitter gourd, brinjal and potato should be included in the daily diet since they contain low sodium and high potassium. Hypertensive patients with kidney disease should avoid a high intake of potassium as it puts an excessive load on the kidney.

Another good source of potassium is celery. It also contains a compound, which acts as a sedative and can lower blood pressure. Garlic and gooseberry are other effective remedies to lower blood pressure. Vitamins should be adequate to the recommended allowances that can be achieved by consuming fruits and vegetables.

Fluids

Fluid restriction is not necessary for hypertension unless the patient is having oedema and heart failure where the fluid restriction is regulated according to the urine output.

Alcohol And Smoking

Alcohol and smoking have adverse effects on hypertension and must be avoided.

Pointers for a Diet for Hypertension Patients

*No extra salt other than the amount prescribed should be used.

*Avoid baking powder and soda in all preparations.

* Avoid salty items, chips, pickles, and papad.

* Avoid canned and tinned foodstuff, which contains salt.

* Avoid salted butter and cheese.

* Avoid sea fish, dried fish, and salted meat.

* If overweight, avoid dried fruits, fried foods, sweets and cakes.

* Sour lime or vinegar may be used to make food palatable.

* Increase fibre in the diet in the form of cereals, vegetables and fruits.

* Poultry without skin is better than other types of meat.

* Take only adequate calories.

About Author

Dr. Priyanka Rohatgi

Dr. Priyanka Rohatgi (M.Sc, PhD, ADND, PGCCGM, XLRI) is Chief Clinical Dietician, HOD, Dept. of Nutrition and Dietetics, Apollo Hospitals, Bangalore. She is also President, Indian Dietetic Association ,Bangalore Chapter (2011-14) and member, National Executive Committee, Indian Dietetic Association.