Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 248

Performing BP measurements in all groups is recommended at each visit. Although this pertains to screening for hypertension in all four categories, it also pertains to hypotension (and associated symptoms) in the Frail, Moderately Demented, and End of Life categories. Recommendations for hypertension screening are based on organizational guideline. The US Preventative Services Task Force (USPSTF) recommends annual screening for hypertension in adults aged 40 years or older who are at high risk for hypertension, which includes those with a BP of 130–139/85–89 mmHg and those who are overweight, obese, or African‐American. In contrast, screening is recommended every three to five years for adults aged 18–39 with a BP less than 130/85 mmHg who do not have other risk factors. If BP is elevated on subsequent measurements, the USPSTF recommends ambulatory BP monitoring or home BP monitoring to confirm the diagnosis of hypertension.⁴ The American Heart Association (AHA) and American College of Cardiology (ACA) recommend treatment for hypertension for BPs greater than 130/80 in all patients with cardiovascular risk factors.⁵ The goal should be individualized in the elderly, especially those greater than >80–85 years of age, to prevent falls and acute kidney injury.⁶ The Assessing Care of Vulnerable Elders (ACOVE) Project recommends screening for systolic hypertension begin at a BP >160 mmHg.

Screening for orthostatic hypotension (OH) is based on evidence that OH is prevalent among older patients (13–30%) and that there is an association between OH and adverse outcomes. The Joint National Committee (JNC) 8 recommends screening all patients treated for hypertension for orthostatic hypotension, but the frequency is not specified.⁶ Although no studies have been carried out to show improved outcomes if this screening is done, the cost and risk of the intervention are low enough that postural blood pressure measurements are recommended.