Hypertension
in the Elderly |
Certified
for 1 AMA PRA Category 1 Credit™
Co-Sponsored
by
the
University of Alabama
School
of Medicine
Division of Continuing Medical Education,
Division of Gerontology, Geriatrics, and
Palliative Care, and
The Center for Aging
| Release
Date: March 7, 2007 |
Expiration
Date: March 7, 2010 |
| TARGET
AUDIENCE: |
| Primary
care physicians |
| OBJECTIVES: |
| Upon
completion of this CME activity,
physicians and other healthcare professionals
should be able to: |
- Discuss cultural awareness needed to improve patients' blood pressure compliance.
- Identify the effect of natural supplements on hypertension.
- Identify and discuss treatment options for drug-resistant hypertension.
- Discuss the role of weight loss, diet, and exercise in the management of hypertension.
|
| Top of Page |
| SOURCE: |
| EDITOR
AND CONTRIBUTING AUTHOR: |
Angela
R. Curtis, PhD
Managing Editor
Assistant Professor, Geriatric Education
Manager
Marisol Lance , MD
Assistant Professor and Staff Physician
Division
of Gerontology, Geriatrics and
Palliative Care
University of Alabama at Birmingham
Birmingham, Alabama |
| Top of Page |
| |
| DISCLOSURE: |
The
faculty has no commercial affiliations
to disclose.
Because of the nature of preliminary
studies, some products mentioned are
unlabeled and investigational. Dosages,
indications, and methods of use of
drugs mentioned in this publication
may reflect the experience of the authors,
clinical literature, or other resources.
Therefore, please see the full prescribing
information before using any licensed
product mentioned. |
| CME
PARTICIPATION: |
| To
participate in this online course
for CME credit, please review the
objectives before beginning the program.
Complete the course and the self-assessment
test before March 5, 2010 to receive
CME credit. Your certificate will
then be available online. This process
should take approximately 1 hour. |
| ACCREDITATION: |
The
University of Alabama School of
Medicine is accredited by the Accreditation
Council for Continuing Medical
Education to provide continuing
medical education for physicians.
The
University of Alabama School of
Medicine designates this educational
activity for a maximum of 1 AMA
PRA Category 1 Credit™.
Physicians should only claim credit
commensurate with the extent of
their participation in the activity.
The
boards of nursing in many states,
including Alabama, recognize Category
1 continuing medical education
courses as acceptable activities
for the renewal of license to practice
nursing. |
| DISCLAIMER: |
| Dosages,
indications, and methods of use of
any drug referred to in this publication
may reflect the clinical experience
of the authors, clinical literature,
or other clinical resources. Therefore,
please see the full prescribing information
before using any product mentioned.
UAB is an equal opportunity/affirmative
action institution. |
| INTRODUCTION: |
People of Hispanic origin are the fastest growing ethnic minority in the United States and often have hypertension and other comorbidities that contribute to atherosclerosis. Despite this observation, the Sixth and Seventh Reports of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI, JNC-VII) acknowledge a difference in prevalence and blood pressure (BP) control rates among minority populations.
However, no specific treatment recommendations are made for Hispanic patients.
The Hispanic Advisory Board for Hypertension Working Group was created in 2003 to bring together experienced Hispanic physicians representing different regions of the United States with the goal of identifying differences in awareness, educational language, and cultural practice patterns that lead to the undertreatment of hypertension in the Hispanic community. The following case presentations begin to identify the challenges and issues that are involved in the treatment of hypertension in older Hispanics. |
| CASE 1: |
Presentation and History
An 84-year-old widowed, Cuban housewife and 30-year resident of the United States presented with acute neurological symptoms of headache, dizziness, blurred vision, and unstable gait, accompanied by hypertension (BP 170/112 mm Hg). Her medical history included uncontrolled hypertension, obesity, dyslipidemia, and osteoarthritis. This is the first time she presented with neurological symptoms; there is no history of cerebrovascular accident. She took garlic pills to improve her health, included grapefruit juice in her diet, and maintained a low-salt diet. The patient believed that “strong emotions” played a role in her illness.
Physical Examination and Laboratory Studies
Physical examination revealed an elderly, obese Hispanic woman. Electrocardiogram and Holter monitor indicated a supraventricular arrhythmia; an echocardiogram showed decreased left ventricular compliance and left ventricular hypertrophy. Doppler imaging revealed 25% to 30% stenosis of the carotid arteries. A chemistry panel, complete blood count, and urinalysis were within normal limit; however, lipid panel abnormalities included elevations of total cholesterol (312 mg/dL) and low-density lipoprotein cholesterol (216 mg/dL).
Diagnosis and Specific Treatment Recommendations
The patient’s diagnoses were left-sided heart failure and carotid atherosclerosis compatible with malignant, uncontrolled hypertension, and presumed cerebrovascular accident. The patient’s BP goal was set at 120/80 mm Hg. She was instructed to reduce the fat in her diet, to keep her salt intake low, and to reduce her overall caloric intake. Amlodipine plus benazepril 5 mg/20 mg once daily was prescribed to control hypertension. Additional medical therapy included clopidogrel 75 mg once daily for secondary prevention of ischemic stroke, a statin for hypercholesterolemia, pravachol 40 mg at dinner time, lansoprazole 30 mg per day for indigestion, and up to 3 grams of Tylenol daily for osteoarthritis. |
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