Unexplained High Blood Pressure in Older Adults

Abnormal hypertension

My father, 76 years old, has no history of hypertension.
Recently, he suffered three fractures in his toes due to external force without realizing it and sought treatment from a traditional Chinese medicine practitioner, where he received acupuncture and topical ointments.
This led to the development of blisters and infection at the injury site, causing the skin to turn black.
A local hospital recommended transferring him to a medical center.
Upon arrival at the hospital, his blood pressure was consistently high, ranging from 190 to 209, although he did not exhibit any discomfort.
Occasionally, his readings would drop to 146.
The physician was hesitant to prescribe antihypertensive medication.
I would like to know what conditions could lead to such high blood pressure and what potential dangers might be associated with it.

Huang Xiao-zhen, 40~49 year old female. Ask Date: 2020/06/27

Dr. Wu Xueming reply Cardiology

More than 95% of hypertension cases are classified as primary hypertension with unknown causes, which may be related to genetics, environment, and diet.
Less than 5% of hypertension cases are secondary hypertension caused by endocrine disorders, kidney diseases, or vascular diseases.
Factors contributing to hypertension include: (1) Fluid factors: excessive salt intake.
(2) Neurogenic factors: anger, stress, anxiety, insomnia, smoking, etc.
(3) Hemodynamic factors: mild exercise (increases systolic blood pressure, decreases diastolic blood pressure); vigorous exercise (increases systolic blood pressure).
(4) Endocrine factors: menopause, genetics, etc.
(5) Cardiovascular factors: obesity, age, sudden changes in climate, alcohol consumption, etc.
Hypertension can continuously damage blood vessels and organs even in the absence of symptoms, leading to complications such as: left ventricular hypertrophy, heart failure, myocardial infarction, arteriosclerosis, stroke, vision impairment, retinal detachment, hearing loss, decreased kidney function, and even renal failure.
Therefore, it is recommended that your father visit a cardiology clinic for a detailed examination and treatment.

Reply Date: 2020/06/27

More Info

Understanding unexplained high blood pressure in older adults, particularly in a case like your father's, involves a multifaceted approach to identify potential causes and associated risks. Your father, at 76 years old, has suddenly developed high blood pressure (hypertension) after an incident that led to foot injuries. This situation raises several important considerations.

Potential Causes of Sudden Hypertension
1. Stress and Pain Response: The acute pain and stress from the foot injuries could trigger a temporary increase in blood pressure. The body's stress response releases hormones such as adrenaline and cortisol, which can cause blood vessels to constrict and heart rate to increase, leading to elevated blood pressure.

2. Medication Effects: If your father received any medications, including over-the-counter pain relievers or topical treatments, these could potentially influence blood pressure. Certain medications, especially non-steroidal anti-inflammatory drugs (NSAIDs), can cause fluid retention and increase blood pressure.

3. Underlying Conditions: While your father may not have a prior history of hypertension, it is possible that underlying conditions such as kidney disease, hormonal imbalances (like hyperaldosteronism), or other cardiovascular issues could be contributing to the sudden rise in blood pressure.
4. Secondary Hypertension: Less commonly, secondary hypertension can result from identifiable causes such as renal artery stenosis, endocrine disorders (like pheochromocytoma), or sleep apnea. Given your father's age, it is crucial to rule out these conditions.

5. Dehydration or Fluid Imbalance: If your father has not been adequately hydrated, especially after an injury, this could lead to changes in blood volume and subsequently affect blood pressure.

Risks Associated with High Blood Pressure
Even in the absence of symptoms, high blood pressure poses significant risks, particularly in older adults. Chronic hypertension can lead to:
- Cardiovascular Disease: Increased risk of heart attack, heart failure, and arrhythmias due to the strain on the heart.

- Stroke: High blood pressure is a major risk factor for both ischemic and hemorrhagic strokes.

- Kidney Damage: Hypertension can lead to chronic kidney disease or worsen existing kidney issues.

- Vision Loss: Hypertensive retinopathy can occur, leading to vision problems or blindness.

- Cognitive Impairment: There is evidence linking hypertension to cognitive decline and dementia.

Management and Recommendations
Given the elevated blood pressure readings (190-209 mmHg), it is essential for your father to undergo a thorough evaluation by a healthcare professional. While the absence of symptoms may seem reassuring, the risks associated with sustained high blood pressure necessitate careful monitoring and potential intervention.

1. Comprehensive Evaluation: A detailed assessment including blood tests, kidney function tests, and possibly imaging studies to evaluate for secondary causes of hypertension is recommended.

2. Lifestyle Modifications: Encourage your father to adopt heart-healthy lifestyle changes, including a balanced diet low in sodium, regular physical activity (as tolerated), and stress management techniques.

3. Medication Management: If hypertension persists, a healthcare provider may consider starting antihypertensive medications. The choice of medication will depend on your father's overall health, any other existing conditions, and potential interactions with other treatments he may be receiving.

4. Regular Monitoring: Regular blood pressure monitoring at home can help track changes and provide valuable information to healthcare providers.

In conclusion, while your father's sudden high blood pressure may be linked to stress and pain from his injuries, it is crucial to explore all potential causes and risks associated with hypertension. A proactive approach involving medical evaluation and lifestyle changes can help manage his blood pressure effectively and reduce the risk of serious complications.

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