Title : management of arterial hypertension and diabetes in elderly people as well as COVID-19 prevention
70% of people over 65 are hypertensive; high blood pressure increases the risk of exposure to cardiovascular disease (myocardial infarction and heart failure) and stroke. This is a public health problem, given the aging of the population.
There are few studies carried out in elderly subjects. This randomized study published in 2008 in the New England Journal of Medicine, compares two groups of patients aged 80 to 105 years. The first group receives antihypertensive treatment with diuretics +/- EIC, while the other group receives the placebo treatment. The results show a significant reduction in mortality, fatal strokes and heart failure (hypertension study in very Elderly trial).
The specific of the elderly subject:
- HTA is mostly systolic
- the blood pressure objectives are different according to age under 80: the objectives are the same as in the general population: <140/90mmhg
- In the over 80s, the objectives are less strict, they tolerate a SBP<150mmhg in the absence of orthostatic hypertension.
- Look for orthostatic hypertension causing falls and loss of autonomy.
- Beware of the white coat effect. Do not hesitate to offer self-measurement of blood pressure or ambulatory measurement of blood pressure (MAPA).
- No strict salt-free diet, as it exposes you to a major risk of undernutrition.
- In the event of systolic hypertension, the classes of drugs used in first intention are diuretics, thiazides and calcium channel blockers in monotherapy and progressive increase in dosage.
- In the case of systolic-diastolic hypertension, drugs from the 5 therapeutic classes can be prescribed.
- After 80 years it is better to limit yourself to 3 antihypertensives, in order to limit polymedication and the risk linked to iatrogenic
About the management of diabetes
- proposed treatment is discussed with the patient's family: basal insulin therapy 1-2*/day
- Teaching on the prevention and treatment of hypoglycaemia.
- Home supervision: nursing visit 2*/day for injection and blood sugar control, meals delivered, blood sugar targets:*10mmol
- rehabilitation of the treatment on a weekly basis over a month.
- Reassessment of glycemic targets with the patient and his family.
- Monitoring of the overall functional state:
- Geriatric syndrome: with cognitive, nutritional, motor and balance assessment and rehabilitation of treatment one week, one month, three months from the start of treatment
In summary In developed countries, about 12-25% of people over 65 are diabetic. The management of diabetes in the elderly is less well studied than in other age categories. Recently, the diabetology and geartrie companies have taken a position on the priorities and specificities of this care. The adjustment of drug treatment, as well as the glycemic targets adapted to the functional state of the patient must prevent the symptoms of diabetes and delay the onset of geartric syndromes.
The prevention and screening of classic complications of diabetes and geartric syndrome must be integrated into the care of the elderly, in order to optimize their overall health and their quality of life.