case of hypertension in the elderly

Introduction

A 72 yo woman seen in clinic for routine followup. She is independent of all ADLs and iADLs. She continues to drive and reports no automobile accidents. She appears in clinic unaccompanied.

She reports that her previous physician expressed concern regarding her blood pressure (BP) and advised her to monitor her BP at home. She reports her blood pressures have been between 140-150/80-80. She adheres to a low-salt diet and exercised regularly. Shed denies symptoms of orthostasis and has had no falls.

History

• Past medical history:
  • never smoker
  • menopause at age 51
• Social history:
  • married
  • retired school teacher

Physical examination

• supine blood pressure 147/75 (right arm), repeat 146/76 (left arm) with heart rate of 70/min
• standing blood pressure 145/75 with heart rate of 72/min
• no murmurs, rhythm regular
• Lungs clear, no peripheral edema
• Exam unremarkable

Dosage

• none

Laboratory

• serum creatinine 0.8 mg/dL
• serum potassium 4.2 mmol/L
• urinalysis is normal

Diagnostic procedures

• electrocardiogram is normal
  • no left ventricular hypertrophy or left atrial enlargement

Management

• continue home blood pressure monitoring
  • no antihypertensive treatment indicated
  • JNC8 recommends treatment of chronic hypertension with antihypertensive in patients >= 60 years of age when blood pressure is > 150/90 mm Hg
• yearly influenza vaccine (due in autumn)
• Pneumovax received at age 65, PCV13 received 2 years ago
• Tdap received 2 years ago
• shingles vaccine received last year
• consider discussing advance directives

More general terms

• case presentation

Additional terms

• advance directives