Hypertension and Endocrine Disorders in Old Age Patients
Systolic hypertension is more common in elderly patients. Elevated systolic blood pressure readings are usually caused by increased CO, systemic vascular resistance, or both. The main vascular cause of systolic hypertension is rigidity of the aorta, which develops from arteriosclerosis and increases total peripheral vascular resistance. Normally, the elastic aorta stretches as blood is pumped from the heart, but with decreased elasticity and compliance, systolic pressure increases significantly.
Aging also causes hyaline degeneration of the tunica media of arterioles, reducing lumen size. Further, decreased baroreceptor sensitivity may contribute to increased sympathetic nervous system activity and elevated levels of norepinephrine.
About 45% of the elderly in the United States have systolic blood pressures of 160 mm Hg or higher and diastolic pressures of less than 90 mm Hg-a condition known as isolated systolic hypertension. Generally, this condition reflects a disease process resulting in lost elasticity of the aorta and its large branches. Other than advanced age, this condition is the greatest risk factor of endocrine disease in elderly patients.
Endocrine Disorders
Pheochromocytoma, an abnormal growth of new tissue on the adrenal medulla, produces excessive catecholamines, causing hypertension. These tumors occur most commonly in patients ages 40 to 60, and about 90% of them are benign.
A patient with pheochromocytoma may experience severe headaches, profuse sweating, palpitations, and pronounced pallor caused by a sudden release of catecholamines resulting in a hypertensive crisis. These attacks can be triggered by physical activity, postural changes, emotional distress, hypoglycemia, and surgical trauma. An attack may also be provoked when the tumor is palpated.
If left untreated, a patient with pheochromocytoma can develop diabetes, cardiomyopathy, and hypertension, any of which can result in death. The usual treatment is surgical removal of the tumor, which relieves hypertension in about 75% of patients. The remaining 25% can usually manage their hypertension with antihypertensive drug therapy.
Caused by excessive aldosterone secretion of the adrenal gland, primary hyperaldosteronism is another endocrine disorder that causes hypertension. This condition is more common in women ages 20 to 50. Suspect it in hypertensive patients who have hypokalemia and don’t take diuretics.
The three causes of primary hyperaldosteronism are unilateral adrenocortical adenoma, adenomatous hyperplasia, and adrenocortical carcinoma. Unilateral adrenocortical adenoma alone causes 80% to 85% of the cases of primary hyperaldosteronism.
Physicians typically treat primary hyperaldosteronism by surgically removing the tumor. Unfortunately, surgery generally doesn’t cure hypertension resulting from adenomatous hyperplasia.
Cushing’s syndrome, another cause of hypertension, results from either prolonged treatment with large doses of glucocorticoids or excess cortisol production by the adrenal cortex, which is most commonly caused by a pituitary tumor. In either case, hypertension results from the mineralocorticoid effects of the hyperfunctioning adrenal tissue. When a pituitary tumor causes Cushing’s syndrome, the usual treatment consists of surgical removal. Hypertension can also be caused by acromegaly-a chronic metabolic condition resulting from excessive production of growth hormone in the anterior pituitary. The condition is characterized by enlargement and elongation of the bones of the face, jaw, and extremities. Although onethird of patients with acromegaly have hypertension, it’s usually not severe, and the treatment of acromegaly-surgery, radiation, and drugs-usually alleviates the hypertension.
Tags:hypertension is rigidity of the aorta, isolated systolic hypertension, reducing lumen size surgical removal of the tumor
At first, many patients with hypertension have no symptoms. As the disease progresses, some patients actually become accustomed to its symptoms-headaches, dizziness, and blurred visionand view them as insignificant. Thus, diagnosing and treating hypertension may require a thorough patient assessment. This usually includes obtaining and interpreting a patient’s health history, performing a physical examination, taking blood pressure readings, and monitoring the results of diagnostic tests.You also may use your assessment skills to help identify someone who may develop hypertension. And you may use them to evaluate a patient who has just been diagnosed with hypertension, to monitor a hypertensive patient’s treatment, and to detect complications resulting from hypertension.
By guiding a hypertensive patient through the initial phases of detection and education about his condition, you playa leading role in his plan of care. For the first step in this process, obtain the patient’s health history, which should include risk factors, medical history, and any social characteristics that might influence his response to the disease or its treatment.Hypertension seems to be hereditary. If a patient’s parents have hypertension, he has twice the risk of developing it as someone whose parents don’t have it. When obtaining a hypertensive patient’s family history, ask about his parents, grandparents, siblings, and children. Record their ages and general states of health. If one of these family members is dead, find out the cause of death and the age at the time of death.
nst the arterial wall, usually the brachial artery wall. A blood pressure of 120/80 mm Hg is considered normal. The “120 mm Hg” is the systolic pressure-the force exerted against the arterial wall when the heart’s ventricles contract. During systole of the cardiac cycle, the elastic walls of the aorta and arteries stretch as more blood enters the ventricles. Ventricular pressure builds, causing the ventricles to contract and the aortic valve to open. The peak pressure of blood being forced through the aorta is the systolic pressure.