Current challenges in antihypertensive treatment in the elderly

Abstract

is attributed to the gradual increase in SBP that comes with aging, whereas DBP tends to decline after 60 years of age, and thus the majority of elderly hypertensive patients have increased pulse pressure and isolated systolic hypertension. 4,5 Many aspects of hypertension treatment are similar in younger and older patients. However, given the unique features of hypertension in the elderly, several challenges arise that physicians have to deal with in daily clinical practice. 6 Target BP and optimal hypertensive treatment seem to be different between young and old patients. Trials in the elderly population using BP-reducing treatment seem to have provided a safe BP threshold of less than 150 mmHg to reduce morbidity and mortality events in fit elderly patients; on the contrary, data are inconclusive for the optimal antihypertensive strategies in frail elderly patients and those residing in nursing homes. 7Introduction Hypertension is a public health problem that affects almost 1 billion adults worldwide, and this number is estimated to reach 1.5 billion by 2025. The global prevalence of hypertension is increasing with age; approximately half of the population aged between 60 and 69 years and more than 60% of those over the age of 70 years are hypertensive. 1 Data from the Framingham study 2 suggest that normotensive men and women at the age of 55 years have a 93% and 91% lifetime risk of developing hypertension, respectively. Increased blood pressure (BP) has been independently associated in all ages with increased incidence of cardiovascular (CV) events, such as stroke, coronary artery disease, myocardial infarction, sudden death, and heart failure. 3 In the elderly population, systolic BP (SBP) and pulse pressure were shown to be better predictors of CV outcomes than diastolic BP (DBP). This ABSTRACTArterial hypertension affects more than 25% of the global population, and its prevalence is increasing with age. Arterial stiffening occurs with aging and results in a pattern of increased systolic and decreased diastolic blood pressure (BP). In the elderly population, elevated BP has been related with increased cardiovascular risk. Trials on this population have shown great benefits for morbidity and mortality from reducing systolic BP (SBP) levels to less than 150 mmHg. Most guidelines for the management of elderly hypertensive patients agree on BP reduction to less than 150/90 mmHg. However, there is still uncertainty whether further BP reduction could provide beneficial results. The recently published SPRINT trial demonstrated that reducing SBP to between 120 and 125 mmHg in patients over the age of 75 years is related with increased survival and is expected to affect future recommendations. On the contrary, the limited data that are available for patients aged 80 years or older and frail nursing home patients create concerns for more aggressive BP strategies in these subgroups, and thus they should be treated more conservatively. Among the various antihypertensive classes of drugs, diuretics, calcium channe...

Prescribing or deprescribing in older persons: what are the real-life concerns in geriatric practice?

“…33 However, nowadays an optimal treatment of older adults is a challenge for many other clinicians. 34,35 Our study has 2 limitations. First, we did not consider the changes in drug doses and we refrained from qualitative and health -oriented evaluation of alterations in drug regimen, which we leave for further investigations.…”