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Blood Pressure Management and Hypertension in DM-ADRD
*Given high risk of falls, patient should be monitored closely for hypotension. If patient is unable to tolerate <140/90 mmHg, of course, a higher blood pressure would be set as a goal.
Hypertension
Treatment of hypertension to individualized target levels is indicated in older adults with DM and ADRD. Refer to the NYUPN Guideline for Hypertension Management for details on medication management.
For persons with ADRD, DM, and hypertension, the goal of therapeutic intervention should be to lower blood pressure within 3 months if systolic blood pressure is 140 to 160 mmHg or diastolic blood pressure is 90 to 100 mmHg or within 1 month if blood pressure is greater than 160/100 mmHg
There is potential harm in lowering systolic blood pressure to less than 120 mmHg in older adults with ADRD and DM. Increased attention should be paid to symptoms of orthostatic hypotension
First line therapy includes thiazide diuretics, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, or calcium channel blockers.
Joshua Chodosh, MD, MSHS, FACP Michael L. Freedman Professor of Geriatric Research in Medicine, Interim Director, Division of Geriatrics and Palliative Care, Director, Freedman Center on Aging, Technology and Cognitive Health (CATCH), Director, NYU-CDC BOLD Public Health Center of Excellence on Early Dementia Detection, Co-Director, NYU Aging Incubator, Professor of Medicine and Population Health
EQUIPED-ADRD An enhanced quality improvement initiative (QI) to improve ambulatory care for older patients with Diabetes Mellitus and Alzheimer’s Disease and Related Dementias (DM-ADRD) and their caregivers.
