Prevalence, prescribing and barriers to effective management of hypertension in older populations: a narrative review

Abstract

ObjectivesHypertension is the leading modifiable cause of mortality worldwide. Unlike many conditions where limited evidence exists for management of older individuals, multiple large, robust trials have provided a solid evidence-base regarding the management of hypertension in older adults. Understanding the impact of age on how the prevalence of hypertension and the role of pharmacotherapy in managing hypertension among older persons is a critical element is the provision of optimal health care for older populations. The aim of this study was to explore how the prevalence of hypertension changes with age, the evidence regarding pharmacological management in older adults and to identify known barriers to the optimal management of hypertension in older patients.MethodsA review of English language studies published prior to 2013 in Medline, Embase and Google scholar was conducted. Key search terms included hypertension, pharmacotherapy, and aged.ResultsThe prevalence of hypertension was shown to increase with age, however there is good evidence for the use of a number of pharmacological agents to control blood pressure in older populations. System, physician and patient related barriers to optimal blood pressure control were identified.ConclusionsDespite good evidence for pharmacological management of hypertension among olderpopulations, under treatment of hypertension is an issue. Concerns regarding adverse effects appearcentral to under treatment of hypertension among older populations.

Factors associated with hypertension and its management among older rural Australians

“…Several barriers to the optimal management of hypertension among older adults have been identified and tend to be system‐, physician‐ and patient‐related, such as uncertainty around the applicability of management guidelines for older persons and patient adherence to treatment for a largely asymptomatic condition 22 . This is despite the fact that treatment of hypertension in the elderly has been associated with a decrease in cardiovascular morbidity and mortality 8 …”

Cardiovascular Effects of Covid-19 Pandemia

“…Pandeminin başlarında gerek virüsün ACE2 kullanması gerekse HT olan hastalarda, hastalığın daha ölümcül seyretmesi özellikle anjiyotensin 1 reseptörü (AT1r) blokajı üzerinden etki eden anti-HT ilaçların suçlanmasına neden olmuştur. Unutulmamalıdır t ki COVID-19 hastalarında en yüksek mortalite ve morbidite 65 yaş üzerinde (%84) olmakta, fakat bu hasta grubunda HT ve KV risk prevelansının da benzer oranlarda olduğu görülmektedir (>60 yaş %65) (17). Bu nedenle COVID-19 hastalarında mortalite ve morbidite ile HT birlikteliğini araştırmak için eldeki veriler yeterli görünmemektedir.…”

Prevalence, management and control of hypertension in older adults on admission to hospital

“…The prevalence of hypertension increases with age, and it is estimated that older adults over the age of 65 years account for 70% of all adult hypertension in developed countries (Logan, 2011, Pimenta and Oparil, 2012). While the prevalence of hypertension in older adults is high, there is robust evidence regarding the benefits of good blood pressure (BP) control within this population, in terms of reduced mortality and morbidity (Wing et al, 2003, Bulpitt et al, 2011, Dahlöf et al, 1991, Alhawassi et al, 2015). A recent Cochrane review examining 15 clinical trials looking specifically at pharmacotherapy for hypertension in older patients found that treating those aged 60 years or older with mild to moderate hypertension reduced both all cause mortality and cardiovascular morbidity and mortality in older people (Musini et al, 2009).…”