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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 retinopathy.

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 accident.

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 effective.

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

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