Therapy of hypertension in elderly population and its potential risks

Czech version

Authors: Jiří Widimský
Authors‘ workplace: III. interní klinika VFN a 1. LF UK Praha
Published in: Vnitř Lék 2022; 68(7): 461-464
Category:
doi: https://doi.org/10.36290/vnl.2022.097

Overview

Arerial hypertension is comon in subjects ≥ 65 years old and includes in majority of subjects systolic/diastolic form or isolated systolic hypertension. Basic therapeutic principles to the therapy of hypertension of elderly subjects are summarized. Slow and careful uptitration of antihypertensive therapy is recommended. Potential complications and caveats of therapy are also discussed, which are especially related to older frail subjects. Pharmacotherapy of hypertension in elderly is in vast majority of subjects highly beneficial with decrease of cardiovascular (CV) events and CV mortality.

Keywords:

elderly – risk – arterial hypertension – therapy – benefit

Sources

1. Burt VL, Whelton P, Roccella EJ et al. Prevalence of hypertension in the US adult population: results from the third National Health and Nutrition Examination Survey, 1988-1991. Hypertension. 1995;25 : 305-13.

2. Kannel WB, Wolf PA, McGee DL et al. Systolic blood pressure, arterial rigidity and stroke. The Framingham study. JAMA. 1981;245 : 1225-8.

3. Psaty BM, Furberg CD, Kuller LH. et al. Association between blood pressure level and the risk of myocardial infarction, stroke, and total mortality. Arch Intern Med. 2001;161 : 1183-92.

4. Benetos A, Thomas F, Bean K et al. Prognostic value of systolic and diastolic blood pressure in treated hypertensive patients. Arch Intern Med. 2002;162 : 577-81.

5. The Task Force for the management of arterial hypertension of the European. Society of Cardiology and the European Society of Hypertension. ESH/ESC guidelines for the management of arterial hypertension: J Hypertens. 2018;36 : 1953-2041.

6. Widimský J jr., Filipovský J, Ceral J et al. Diagnostické a léčebné postupy u arteriální hypertenze –⁠ verze 2017. Doporučení České společnosti pro hypertenzi Vnitřní lékařství 2018,7-8,771-796.

7. Beckett NS, Peters R, Fletcher AE et al. for the HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358 : 1887-1898.

8. Williamson JD, Supiano MA, Applegate WB et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years. A randomized clinical trial. JAMA. 2016; doi:10.1001/jama.2016.7050.

9. Benetos A, Petrovic M, Strandberg T. Hypertension management in older and frail older subjects. Circ. Res. 2019,124,1045-1060.

10. Butt DA, Harvey PJ. Benefits and risks of antihypertensive medications inthe elderly J. Intern Med. 2015;278 : 599-626.

11. Mohandas R, Chamarthi G, Bozorgmehri S et al. Pro Re Nata Antihypertensive Medications and Adverse Outcomes in Hospitalized Patients: A Propensity‑Matched Cohort Study. Hypertension. 2021;78 : 516-524.