Hypertension treatment in elderly patients in 2019: well-known, hot-topics and surprises

Цыганкова, О. В.; Troshina, M. S.; Latyntseva, L. D.

doi:10.37586/2686-8636-1-2020-64-73

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…Закономерно, что с повышением возраста растет и распространенность АГ. В Российской Федерации АГ после 60 лет встречается в 60%, а после 80 лет количество таких пациентов составляет 80% [8]. Доля лиц с АГ среди пациентов, обращающихся в поликлиники по поводу ССЗ, составляет >90% [9].…”

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Features of multimorbidity in elderly and senile people with hypertension

2021

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Aim. To reveal the features of multimorbidity in elderly and senile people with hypertension (HTN).Material and methods. A total of 70 elderly and senile hypertensive patients were examined at one of the Arkhangelsk outpatient clinics (from 60 to 90 years old; mean age — 69,14±1,34 years), including those aged 60-74 years (n=56; (80,0%) and 75 years and older (n=14; 20,0%). We assessed the questionnaire survey data, the outpatient medical records, the clinical status, and the cumulative illness rating scale for geriatrics (CIRS-G).Results. The analysis showed a high prevalence of multimorbidity in elderly and senile people with HTN, which was found in all patients. On average, an elderly patient with HTN has 6 diseases that are pathogenetically interrelated and unrelated, while a senile patient has 8 diseases. The most common comorbidities were gastrointestinal (81,43%), musculoskeletal (77,14%) and endocrine (77,14%) diseases. Among the cardiovascular comorbidities in the elderly with HTN, the following were more common: heart failure (54,29%), coronary artery disease (angina pectoris — 41,43%) and cerebrovascular diseases (28,57%) (stroke/transient ischemic attack, vascular encephalopathy). Patients with HTN took an average of 6 different drugs at the same time. There was moderate comorbidity level in the elderly patients and a high one in those of senile age.Conclusion. In elderly and senile patients with HTN, there is a high prevalence of multimorbidity, which must be taken into account when preventing polypharmacy.

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Section: результатыunclassified

Features of multimorbidity in elderly and senile people with hypertension

2021

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Postprandial Hypotension in Elderly Patients: Pathophysiology, Diagnosis and Prevention Measures

Antropova,

Efremushkina

2024

Arhivʺ vnutrennej mediciny

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Postprandial hypotension (PPH) is an important but underrecognized condition resulting from an inadequate compensatory cardiovascular response to meal-induced visceral blood pooling. PPG is recognized as an important clinical problem because it has a high prevalence in the older age group and is associated with the development of cardiovascular complications and geriatric syndromes. Possible pathophysiological mechanisms of PPG: increased visceral blood flow; weakening of baroreflex function due to disorders associated with age or autonomic dysfunction; inappropriate activation of sympathetic nerves; dysregulation of vasoactive intestinal peptides; insulin-mediated vasodilation. Ask about symptoms of postprandial hypotension and a decrease in systolic blood pressure (BP) of ≥20 mm Hg. Art. 15-60 minutes after eating is of paramount importance for making a diagnosis of PPG. One of the main strategies for preventing PPG is to reduce gastric distension (small meals and more frequent meals), resting on your back after eating, and drinking enough water. Walking after eating also appears to help restore blood pressure after eating. Caution should be exercised when prescribing protein supplements in the elderly, modifying the diet by replacing high-nutrient sweeteners with low-calorie sweeteners (d-xylose, xylitol, erythritol, maltose, maltodextrin, and tagatose). Metformin or acarbose modulates the cardiovascular response in patients with diabetes mellitus and reduces postprandial hypotension. Thus, PPG is a fairly common and clinically significant phenomenon in elderly patients. Increasing the awareness of doctors about pathophysiology and methods of diagnosis and prevention will improve the efficiency and safety of managing geriatric patients.

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Features of antihypertensive pharmacotherapy in patients with metabolic syndrome and diabetes mellitus

Vlyubchak

Дутова

Romanova

2021

SMJ

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The article describes the results of analyzing the available literature concerning specifics of pharmacotherapy for hypertension in elderly patients and patients with metabolic syndrome and diabetes mellitus. Authors present statistical data on the prevalence of hypertension among elderly patients and the incidence of obesity and diabetes in the Russian Federation. The paper highlights the characteristics of clinical course of hypertension in the older age group including the predominance of isolated systolic hypertension, vascular stiffness, and increased endothelial dysfunction. The need for administration of antihypertensive drugs to reduce the risk of complications and improve the quality of life even in older patients is confirmed. The analysis of data from numerous large studies allowed the authors to identify the main principles for selecting antihypertensive drugs in elderly patients. Slow calcium channel blockers, angiotensin converting enzyme inhibitors, and low-dose diuretics should be prescribed as first-line drugs. At the next stage of treatment, in case of unsatisfactory results of initial therapy, the addition of mineralocorticoid receptor antagonists, alpha-blockers, and selective imidazoline receptor agonists should be considered. The main approaches to antihypertensive therapy in patients with metabolic syndrome and diabetes mellitus are described. The authors note the fact of unfavorable impact of metabolic syndrome on cardiovascular system, which provides rationale for aggressive treatment of hypertension in such clinical cases where several drugs may be used to achieve a stable antihypertensive effect. Diuretics, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers are recommended as first-line antihypertensive pharmacotherapy in these patients. The authors argue in favour of the use of antihypertensive drug combinations in one dosage form as one of the effective ways to solve the problem of adherence to treatment in elderly patients and patients with concomitant metabolic disorders.

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Hypertension treatment in elderly patients in 2019: well-known, hot-topics and surprises

Cited by 4 publications

References 32 publications

Features of multimorbidity in elderly and senile people with hypertension

Features of multimorbidity in elderly and senile people with hypertension

Postprandial Hypotension in Elderly Patients: Pathophysiology, Diagnosis and Prevention Measures

Features of antihypertensive pharmacotherapy in patients with metabolic syndrome and diabetes mellitus

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