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Blood Pressure Therapy in the Elderly: An Observation in Octogenarians
Sandhya S. Nemade1, Jerry O. Ciocon
1Cleveland Clinic Florida, Naples, FL 34119.
Insights
Treating hypertension in octogenarians is complex due to potential adverse effects. This study found that most elderly patients tolerated antihypertensive medications well, with modest blood pressure reduction achieved.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Hypertension incidence rises with age, posing risks for elderly individuals.
- Treatment benefits are known, but adverse effects in frail elderly patients are a concern.
- Optimal blood pressure targets and medication choices for octogenarians remain challenging.
Purpose of the Study:
- To review the approach to treating hypertension in octogenarians.
- To analyze the effectiveness and tolerability of antihypertensive medications in this age group.
Main Methods:
- Retrospective analysis of 100 hypertensive octogenarian charts.
- Minimum 1-year follow-up period.
- Data collected on blood pressure, medications, and patient tolerance.
Main Results:
- Mean age of study population: 84.7 years.
- Mean blood pressure decreased from 152/83 mm Hg to 145/76 mm Hg (p<0.01).
- Average number of medications increased from 1.2 to 1.6 (p<0.0001).
- Calcium channel blockers, diuretics, and ACE inhibitors were most common.
- Most patients tolerated medications well.
Conclusions:
- Antihypertensive therapy can be safely administered to most octogenarians.
- Modest blood pressure reduction was achieved with increased medication use.
- Further research is needed to define optimal treatment strategies for this population.
Abstract:
The incidence of hypertension increases with age. Although there is ample evidence regarding the benefit of treating elderly hypertensive patients, resulting in decreases in cardiovascular morbidity and mortality, the adverse effects of treatment are also frequently reported in these often frail individuals. Therefore, it is difficult to determine the level to which blood pressure should be decreased and what type of antihypertensive medication is most effective and best tolerated. The approach to treating hypertension in octogenarians at the Cleveland Clinic Florida was reviewed. An analysis of 100 consecutive charts of hypertensive octogenarians treated by internists from January 1, 1993, with a minimum of 1 year follow up, was carried out. The mean age of the population studied was 84.7 years (range, 80-97Â+/-4.13 years). The mean initial blood pressure was 152/83 mm Hg, and the mean final blood pressure was 145/76 mm Hg (pless than 0.01). The initial number of medications used was 1.2, which rose to 1.6 by the final reading (pless than 0.0001). The most frequently used drug classes were calcium channel blockers, followed by diuretics and ACE inhibitors. Most of the octogenarians tolerated their antihypertensive medication well. (c)2000 by Le Jacq Communications, Inc.