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      Management of hypertensive crises in the elderly

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          Abstract

          Hypertensive crises are elevations of blood pressure higher than 180/120 mmHg. These can be urgent or emergent, depending on the presence of end organ damage. The clinical presentation of hypertensive crises is quite variable in elderly patients, and clinicians must be suspicious of non-specific symptoms. Managing hypertensive crises in elderly patients needs meticulous knowledge of the pathophysiological changes in them, pharmacological options, pharmacokinetics of the medications used, their side effects, and their interactions with other medications. Clevidipine, nicardipine, labetalol, esmolol, and fenoldopam are among the preferred choices in the elderly due to their efficacy and tolerability. Nitroprusside, hydralazine, and nifedipine should be avoided, unless there are no other options available, due to the high risk of complications and unpredictable responses.

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          Most cited references90

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          2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

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            American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

            (2015)
            The 2015 American Geriatrics Society (AGS) Beers Criteria are presented. Like the 2012 AGS Beers Criteria, they include lists of potentially inappropriate medications to be avoided in older adults. New to the criteria are lists of select drugs that should be avoided or have their dose adjusted based on the individual's kidney function and select drug-drug interactions documented to be associated with harms in older adults. The specific aim was to have a 13-member interdisciplinary panel of experts in geriatric care and pharmacotherapy update the 2012 AGS Beers Criteria using a modified Delphi method to systematically review and grade the evidence and reach a consensus on each existing and new criterion. The process followed an evidence-based approach using Institute of Medicine standards. The 2015 AGS Beers Criteria are applicable to all older adults with the exclusion of those in palliative and hospice care. Careful application of the criteria by health professionals, consumers, payors, and health systems should lead to closer monitoring of drug use in older adults.
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              2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary

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                Author and article information

                Journal
                J Geriatr Cardiol
                J Geriatr Cardiol
                JGC
                Journal of Geriatric Cardiology : JGC
                Science Press
                1671-5411
                July 2018
                : 15
                : 7
                : 504-512
                Affiliations
                [1 ]Dorrington Medical Associates, Houston, Texas, USA
                [2 ]University of Baghdad/College of Medicine, Baghdad, Iraq
                [3 ]Universidad Autónoma de San Luis Potosí, San Luis Potosí, México
                [4 ]Universidad Durango Santander, Hermosillo, Sonora, México
                [5 ]The University of Texas Health Science Center at Houston, USA
                [6 ]The University of Texas Medical Branch at Galveston, USA
                [7 ]Critical Care Services, United Memorial Medical Center / United General Hospital, Houston, Texas, USA
                Author notes
                Correspondence to: Joseph Varon, MD, The University of Texas Health Science Center at Houston, 2219 Dorrington Street, Houston, Texas 77030, USA. E-mail: Joseph.Varon@ 123456uth.tmc.edu Telephone:+1-713-669-1670 Fax:+1-713-669-1671
                Article
                jgc-15-07-504
                10.11909/j.issn.1671-5411.2018.07.007
                6198269
                30364798
                3c599982-4428-4882-b1a8-3fbd8813341e
                Institute of Geriatric Cardiology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission.

                History
                : 30 May 2018
                : 30 May 2018
                : 30 May 2018
                Categories
                Review

                Cardiovascular Medicine
                beta-blockers,calcium channel blockers,clevidipine,elderly,esmolol,fenoldopam,hypertensive crises,labetalol,nicardipine,nitroprusside

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