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Hypertension in the Aging Patient: New Imperatives, New Options
1Brookdale University Hospital and Medical Center, Brooklyn, NY.
Insights
Systolic hypertension affects over half of U.S. adults aged 65+, increasing cardiovascular risks. Guidelines now focus on aggressive treatment of elevated systolic blood pressure to improve survival and prevent major adverse events.
Area of Science:
- Geriatric Medicine
- Cardiovascular Medicine
- Public Health
Background:
- Hypertension is prevalent in individuals over 65, with systolic blood pressure being a key indicator of cardiovascular events.
- Cardiovascular events are the leading cause of death and disability in the elderly population.
- Current hypertension guidelines emphasize aggressive diagnosis and treatment of systolic hypertension based on clinical trial evidence.
Purpose of the Study:
- To review current guidelines and evidence regarding the diagnosis and treatment of systolic hypertension in older adults.
- To discuss the predictive value of systolic blood pressure for cardiovascular outcomes.
- To highlight the evolving treatment strategies and the need for individualized patient care.
Main Methods:
- Analysis of current hypertension guidelines, including the Sixth Report of the Joint National Committee (JNC VI) and the World Health Organization-International Society of Hypertension (WHO-ISH).
- Review of evidence from large clinical trials demonstrating the benefits of reducing systolic blood pressure.
- Examination of treatment approaches and drug classes used for systolic hypertension in the elderly.
Main Results:
- Hypertension diagnosis is recommended for systolic blood pressure >140 mm Hg, with a treatment target <140 mm Hg.
- Lower treatment targets may be justified for elderly patients with comorbid conditions like diabetes or renal impairment.
- The efficacy of aggressive treatment for systolic blood pressure between 140-159 mm Hg without other risk factors is under ongoing investigation.
Conclusions:
- Reducing systolic blood pressure significantly improves survival and prevents cardiovascular outcomes in older adults.
- Treatment selection should be individualized, considering patient-specific needs and comorbidities.
- Further research is needed to clarify optimal treatment thresholds for certain patient groups.
Abstract:
Over half of all people over the age of 65 in the U.S. have hypertension. In most cases this is diagnosed because of increased systolic blood pressure. It is now recognized that systolic blood pressure is more predictive of cardiovascular events than diastolic blood pressure; since these events are the major cause of death and disability in this population, current hypertension guidelines now emphasize more aggressive blood pressure criteria for both diagnosing and treating systolic hypertension. This process has been stimulated by evidence from large clinical trials that reducing systolic blood pressure improves survival and prevents strokes, heart failure, and other cardiovascular outcomes. The guidelines of both the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) and the World Health Organization-International Society of Hypertension (WHO-ISH) recommend that, regardless of age, hypertension can be diagnosed when the systolic blood pressure is greater than 140 mm Hg. The treatment target is less than 140 mm Hg, though in the presence of concomitant conditions like diabetes mellitus or cardiac or renal impairment, which are common findings in the elderly, even lower target levels may be justified. For patients with systolic blood pressures in the range 140 mm Hg-159 mm Hg but who are without other cardiovascular risk factors, it is not yet certain that aggressive treatment is warranted. New clinical trials are now addressing this question. So far, most experience with treating systolic hypertension in older persons has been with diuretics and calcium channel blockers. But growing evidence indicates that most antihypertensive drug classes are effective and that agents should be selected to best match the needs of individual patients. (c)2000 by CVRR, Inc.