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[Antihypertensive therapy in the elderly: results of large trials]
G Leonetti1, C Cuspidi, M Facchini
1Divisione di Riabilitazione Cardiologica e Malattie dell'Apparato Cardiovascolare, Istituto Auxologico Italiano, IRCCS Ospedale San Luca Via Spagnoletto, 3 20149 Milano.
Insights
Antihypertensive treatment in elderly patients significantly lowers cardiovascular events compared to placebo. Chronic blood pressure management offers more benefits than risks, with various effective agents available.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Context:
- Hypertension is age-dependent, particularly isolated systolic hypertension.
- Elderly hypertensive patients represent a growing population with increased cardiovascular risk.
- Effective management of hypertension in older adults is crucial for reducing morbidity and mortality.
Purpose:
- To evaluate the efficacy of antihypertensive treatment in reducing cardiovascular events in elderly hypertensive patients.
- To compare the outcomes of active antihypertensive therapy versus placebo in this demographic.
- To determine the benefits and risks associated with chronic antihypertensive treatment in older adults.
Summary:
- Clinical trials demonstrate that greater blood pressure reduction through antihypertensive treatment is associated with a lower incidence of cerebrovascular, cardiac, and overall cardiovascular events compared to placebo.
- All tested antihypertensive agents show good efficacy and tolerability in the elderly, though combination therapy is often required to achieve target blood pressure.
- Evidence suggests therapeutic benefits extend up to age 80, with ongoing research exploring benefits in individuals over 80.
Impact:
- Antihypertensive therapy in the elderly provides significant cardiovascular protection, outweighing potential risks.
- The findings support the continued use and optimization of blood pressure-lowering strategies in older hypertensive populations.
- Further research is needed to refine treatment guidelines, particularly regarding systolic blood pressure targets and benefits in the very elderly.
Abstract:
The aim of this review was to evaluate if antihypertensive treatment in elderly hypertensive patients is able to lower the incidence of cardiovascular events when compared to hypertensive controls who received placebo. All trials agree in that the greater blood pressure reduction in hypertensive patients randomized to active treatment is associated with a minor incidence of cerebrovascular, cardiac and all cardiovascular events in comparison to placebo-treated control groups. Therefore the chronic antihypertensive treatment makes more good than bad. All antihypertensive agents have been used for the treatment of arterial hypertension in the elderly and all have shown a good efficacy and tolerability, even if, as in the adult hypertensives, the combination of two or more agents is necessary in the great majority of hypertensive patients to reach the target blood pressure. Because life expectancy is progressively longer and the prevalence of hypertension, in particular isolated systolic hypertension, is age-dependent, it is clinically relevant to investigate if there is an upper limit for the benefit of antihypertensive therapy. The results so far available suggest a benefit up to the age of 80 years, while an ongoing study is aimed at evaluating the benefit of antihypertensive therapy in patients > 80 years. Finally, according to our personal point of view, there are sufficient data to sustain the indication of a diastolic blood pressure reduction between 80 and 90 mmHg, while the indication to a reduction in systolic blood pressure below 140 mmHg is less strong and supported.