Treating Hypertension in the Very Elderly

Abstract

Optimal management of hypertension in the very elderly remains a concern. Few studies have evaluated hypertension in this population, and studies that included patients over 80 enrolled too few to draw conclusions. Although the HYVET (Hypertension in the Very Elderly Trial) study did have adequate power to evaluate the very elderly, because this study was stopped early because of significant findings in mortality, unanswered questions remain regarding optimal BP targets.

Benefits and risks of antihypertensive medications in the elderly

“…However, this study population was healthier than the typical very elderly patient as demonstrated by the fact that the reported prevalence of OH was significantly lower than the US rate for those aged ≥80 years. Furthermore 12% of HYVET participants had a history of CV disease compared to 21% of women and 36% of men in the US general population, and 7% of study participants had a history of DM compared to 21% of US women and men . Similarly, 48% of an elderly outpatient population in the Netherlands suffered from dementia (compared to 0% in HYVET), 22% had a history of stroke (7% in HYVET), 21% had a history of DM (7% in HYVET) and 8% had a history of myocardial infarction (MI) (3% in HYVET) .…”

Blood pressure control in patients with hypertension: a retrospective cohort study

“…Achieving BP targets with anti‐HT medication in elderly patients has been demonstrated as more challenging than younger adults [12,16]. As well as the increased SBP, the importance of advanced age of participants was also reported in the management of uncontrolled HT [17].…”

“…Based on global data, it was predicted that 26.4% of the adult population in 2000 of whom had HT, is going to have an increase to 29.2% by the year 2025 [2]. More than nine million deaths that means 16.5% of all annual deaths are attributed to adverse effects of HT among the global population in comparative risk assessment [4]. Early diagnosis and appropriate treatment is crucial stages in the management of high blood pressure (BP) and its adverse outcomes worldwide [1].…”

Barriers to achieving blood pressure treatment targets in elderly hypertensive individuals

“…8, 9 Achieving BP targets with BP-lowering drugs in elderly patients has been shown to be even more difficult. 10, 11 Therefore, uncontrolled hypertension, despite drug treatment, remains a major public health concern worldwide.…”