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How far should we lower blood pressure in the elderly
1Clinical Hypertension Research, Department of Public Health, University of Uppsala, Sweden. lennart.hansson@geriatrik.uu.se
Insights
Antihypertensive treatment significantly benefits elderly patients with high blood pressure, reducing stroke, coronary issues, and mortality. Lowering blood pressure to normal levels is recommended for this age group to minimize cardiovascular risks.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Recent large intervention trials have investigated hypertension management in the elderly.
- Effective blood pressure lowering in older adults is now an accepted medical intervention.
- Studies demonstrate positive impacts on stroke, coronary morbidity, and overall mortality.
Purpose of the Study:
- To review evidence from major intervention trials on antihypertensive treatment in the elderly.
- To assess the efficacy of various drug classes in managing hypertension in older populations.
- To determine the optimal blood pressure targets for elderly individuals.
Main Methods:
- Review of large-scale intervention trials including HOT, STONE, Syst-Eur, Syst-China, and STOP-Hypertension-2.
- Inclusion of ongoing studies like SCOPE, evaluating angiotensin II receptor antagonists.
- Analysis of data comparing older therapies (diuretics, beta-blockers) with novel agents (calcium antagonists, ACE inhibitors).
Main Results:
- Elderly hypertensive patients benefit from treatment to the same extent as younger individuals.
- Diuretics, beta-blockers, calcium antagonists, and ACE inhibitors have all shown significant benefits.
- Novel therapies demonstrate efficacy comparable to established treatments.
Conclusions:
- Extensive data from large trials support antihypertensive treatment in the elderly.
- Blood pressure should be lowered to normotensive levels in the elderly to reduce cardiovascular risk.
- Further research is encouraged to specifically address optimal targets in this demographic.
Abstract:
In the last few years several large intervention trials have addressed the treatment of hypertension in the elderly and how far blood pressure should be lowered in such patients. The positive results of intervention against high blood pressure in the elderly has resulted in a positive attitude towards treatment and today this is an accepted and highly effective medical intervention. Both stroke and coronary morbidity have been shown to be positively affected as has total mortality. The specific issue, how far to lower blood pressure in the elderly was probably best addressed in the Hypertension Optimal Treatment (HOT) stduy in which about a third of the patients, i.e. >6,000 patients, were > or =65 years of age. In most of the early intervention studies of antihypertensive treatment in elderly patients diuretics or beta-blockers or the two in combination were used as the therapy by which blood pressure was lowered. However, novel therapies, in particular calcium antagonists, have shown benefits of the same magnitude as the older therapies, e.g. in the STONE trial, the Syst-Eur study, the Syst-China study and the STOP-Hypertension-2 study. In the latter study a regimen based on either of two ACE inhibitors was also shown to be equally effective as conventional treatment, based on diuretics and/or betablockers, in the elderly. These trials will be briefly reviewed here as will the SCOPE study which is an ogoing trial in which hypertensive patients aged 70-89 years are being treated with an angiotensin II receptor antagonist under double-blind and placebo-controlled conditions. It can be concluded that a wealth of information, based on large intervention trials, has been accumulated during the last decade. It is quite obvious that the elderly hypertensive patients benefit from antihypertensive treatment to at least the same extent as the young and middle-aged. It appears that blood pressure ought to be lowered down to normotensive values also in the elderly in order to minimize their risk if cardiovascular complications, although more studies would be welcome to address this issue specifically in the elderly.