Blood pressure management in older people: balancing the risks

Abstract

Guidelines of arterial hypertension treatment based on individualised expected outcomes are not available for frail older persons. In this paper, we review the evidence, concerning management of arterial blood pressure (BP) in frail older patients. We focused on the best affordable methods for BP measurement; the age-related optimum BP; specific BP goals in agreement with the patients' general heath, frailty status, orthostatic and postprandial hypotension; balancing the benefits against risks of antihypertensive treatment. Lenient BP goals are generally recommended for older persons with moderate or severe frailty, multimorbidity and limited life expectancy. To this aim, there may be a need for deintensification of antihypertensive treatment.

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“…The blood pressure should be measured supine and after standing or sitting upright for 5 minutes. A decrease in systolic pressure of 20 mmHg or a decrease in diastolic pressure of 10 mmHg, especially when associated with dizziness or light-headedness, are consistent with the diagnosis of orthostatic hypotension [19]. Yet, bedbound persons might be unable to undergo a standard orthostatic test.…”

What are the Tensional Goals in the Frail Elderly?

“…In this studies treatment of hypertension was found to be well The reviews from Correa A, et al [4] and Naschitz J, et al [5] refer that in frail elderly with multiple comorbidities an individualized approach should be considered and the therapeutic targets and regimes should consider risks in this population, such as possible secondary effects, potential drug interactions and that there may be a need for deintensification of antihypertensive treatment [6,7].…”

Vascular Risk Factors and Cognitive Function

“…For example, dementia patients have a higher risk of hip fracture, a powerful determinant mortality in these patients [107], and antihypertensives represent a risk factor for fall injuries in advanced age [108]. Accordingly, older patients with cognitive decline might be the right target for the de-intensification clinical trials that have been proposed for antihypertensive treatment [109].…”