Fishback, David B.
April 1976
Angiology;Apr1976, Vol. 27 Issue 4, p212
Academic Journal
Because of the multiplicity of disease conditions and diminished tolerance for drugs in the aged, it is necessary to know concomitant pathologic conditions to determine which antihypertensive drug to use. In the Philadelphia Geriatric Center, there are about 1,000 residents, between 70 and 100 years of age. About 40% have hypertension; almost 50% have or once had depression; there are many cases of hiatal hernia and/or peptic ulcer; and in one subdivision of residents, almost 40% have renal disease with BUN above 30 mg/100 ml. In antihypertensive treatment, some individuals respond fairly well to reassurance and weight reduction, when obese, even without drugs. All are given a low-salt diet. A diuretic is first used-thiazide in cases of good renal function, furosemide with impaired renal function. Liquid potassium supplements are given. If there is but little reduction in blood pressure in several weeks, methyldopa is added in ascending doses, in cases with or without renal impairment. In hypertension with impaired renal function, furosemide and/or methyldopa were especially valuable. Furosemide as an antihypertensive drug was also noted to delay the onset of congestive heart failure. Since reserpine can aggravate peptic ulcer and can precipitate or aggravate depression, it should seldom be used to treat hypertension in the aged. Guanethidine is rarely used, since it can cause cerebrovascular insufficiency and marked weakness. High blood pressure should be reduced slowly in the aged, to avoid untoward effects. In the Philadelphia Geriatric Center, there are several physicians treating hypertensive residents. I wish to thank the individual doctors of the Philadelphia Geriatric Center whose charts I was able to review, in addition to my own, in order to ascertain their orders and therapy in hypertensive patients-Drs. Morton Ward, the Medical Director; J. J. Cohen, Associate Medical Director; Mitchell A. Selickman; Asher Woldow; Louis Zisserman; and Morton Beck. I also wish to thank the Medical Records Room, Mrs. Lauretto Shore, Director, and her staff, who were of gracious assistance. I am also grateful to Mrs. Mary Morgan, who typed the manuscript.


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