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Outcomes of treating hypertension in the elderly: a short commentary on current issues
1Office of Scientific Affairs, SUNY Downstate College of Medicine, Brooklyn, NY 11203, USA. michaelwebermd@cs.com
Insights
Effective hypertension treatment in the elderly significantly lowers cardiovascular events. Early diagnosis and management, particularly with specific medications, are crucial for preventing strokes and heart issues in older adults.
Area of Science:
- Gerontology and Cardiovascular Medicine
- Pharmacology and Clinical Trials
Background:
- Hypertension in the elderly is common and linked to arterial stiffening, characterized by high systolic and low diastolic pressures.
- While pulse pressure indicates stiffness, advanced noninvasive methods reveal limitations in predicting arterial health from blood pressure alone in older individuals.
- Effective hypertension management in seniors is vital for reducing major cardiovascular events.
Purpose of the Study:
- To summarize the benefits of treating hypertension in the elderly, focusing on cardiovascular event reduction.
- To review findings from major trials like SHEP and Syst-Eur regarding antihypertensive efficacy in older populations.
- To explore the impact of specific drug classes and individual agents on outcomes like stroke, cardiac events, dementia, and diabetes.
Main Methods:
- Analysis of data from landmark clinical trials including the Systolic Hypertension in the Elderly Program (SHEP) and Systolic Hypertension in Europe (Syst-Eur).
- Review of comparative studies on various antihypertensive agents (diuretics, beta blockers, ACE inhibitors, calcium channel blockers, angiotensin receptor blockers).
- Inclusion of findings from the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study, comparing losartan and atenolol.
Main Results:
- Diuretics and calcium channel blockers effectively reduce strokes and cardiac events in elderly hypertensives, including diabetics.
- Calcium channel blockers may reduce new-onset dementia; diuretics show benefits in obese/overweight elderly but not lean individuals.
- The LIFE study indicated angiotensin receptor blocker losartan was superior to beta blocker atenolol in reducing stroke and new-onset diabetes in patients with left ventricular hypertrophy and systolic hypertension.
Conclusions:
- Treating hypertension in the elderly is critical for preventing major cardiovascular events, with specific benefits observed for certain drug classes.
- Individualized treatment approaches may be necessary, considering factors like obesity and specific comorbidities.
- Careful blood pressure control remains paramount for cardiovascular health in elderly patients, including those over 80.
Abstract:
Because treating hypertension in the elderly so effectively reduces major cardiovascular events, it is vital to diagnose this very common condition early. Much of the hypertension that occurs with aging results from stiffening of the major capacitance arteries, typically marked by high systolic and low diastolic blood pressures. Pulse pressure, derived by subtracting diastolic from systolic values, is a useful index of stiffness, but new noninvasive techniques for measurement of arterial compliance have shown that blood pressures cannot reliably predict the state of the arteries in older people. The Systolic Hypertension in the Elderly Program (SHEP) and the Systolic Hypertension in Europe (Syst-Eur) trial demonstrated that treating hypertension in the elderly with diuretics or calcium channel blockers reduces strokes and cardiac events; these results are also clearly evident in high-risk groups like diabetics. Further analysis of Syst-Eur has suggested that a calcium channel blocker reduces new-onset dementia, while follow-up data from SHEP indicate that a diuretic provides survival and stroke benefits in obese or overweight elderly hypertensives, but not in the lean. In general, comparisons of antihypertensive agents, including diuretics, beta blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers have found similar clinical end point effects. But recently, the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study, performed in patients (average age, 67) with left ventricular hypertrophy and predominant systolic hypertension, showed that the angiotensin receptor blocker losartan was significantly more effective than the beta blocker atenolol in reducing such key outcomes as strokes and new-onset diabetes. Even so, careful but effective control of blood pressure in elderly patients, including those over age 80, still remains a critical factor in preventing major cardiovascular events.