Headache, though popularly considered as
symptom of elevated pressure, is characteristic only of
severe hypertension, it is localized to occipital region and
is more severe in the morning. Other complaints include dizziness,
palpitation and easy fatiguability.
A strong family history of hypertension and
intermittent pressure elevation in the past favours the diagnosis
of primary hypertension. Presence of symptoms of underlying
diseases favours a diagnosis of secondary hypertension.
Physical examination should include recording
the blood pressure in supine and standing positions. A rise
in diastolic pressure from supine to standing positions occurs
in essential hypertension and a fall suggests secondary hypertension.
A complete cardiovascular examination may reveal other signs
of hypertension such as loud second sound in aortic area,
ejection systolic murmur. Fundus examination reveals hypertensive
Basic investigations include urine analysis
for albumin, sugar and deposits; patients with features suggestive
of secondary hypertension should be sent to referral centre
for detailed investigation and evaluation.
The main complications are atherosclerosis,
ischaemic heart disease, congestive cardiac failure and cerebrovascular
Uncomplicated primary hypertension may be
treated at the Primary Health Centre itself with an appropriate
anti-hypertensive drug. The patient is also advised salt restriction,
diet restriction, regular mild to moderate exercise and control
of other risk factors contributing to the development of complications.
Reserpine and alphamethyldopa are avoided
in the elderly as they can result in depression with potential
danger of suicide. Nifidipine, a calcium channel blocker which
reduces the irritability of the myocardium and lowers the
preload and the after load of the heart is found to be very
II. Ischaemic Heart Diesases
Ischaemic Heart Diseases occurring in the
elderly are 1. Angina Pectoris and 2. Myocardial infarction.
In Angina pectoris there is severe substernal
squeezing or vague pain or burning sensation, brought on exertion
and relieved by rest, radiating to either side of the sternum,
or back, or neck, or left upper limb along the medial border
and associated with autonomic symptoms such as sweating, nausea
or vomiting. The pain rarely lasts for more than few minutes.
An anginal pain lasting for more than half
an hour and not relieved by rest is usually due to myocardial
infarction, Nocturnal angina occurs due to syphilitic
coronary osteal stenosis. Coronary ischaemia in elderly is due to 1. Atherosclerosis,
2. Systemic hypertension, 3. Diabetes with atherosclerosis,
4. Aortic stenosis, 5. Syphilitic aortitis with aortic incompetence
and coronary osteal stenosis, 6. Presbicardia.
Presbicardia is a condition occurring in
the elderly due to senile cardiac degeneration with multiple
small areas of ischaemia with fibrosis leading onto left sided
failure. There may not be typical anginal pain or ECG changes.
Pulmonary microemboli cause acute dyspnoea
in the elderly. This condition is called superacute 'corpulmonale'.
The diagnosis of bronchial asthma in such cases