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Benefits of blood pressure reduction in elderly patients

Roland Asmar1

  • 1The Cardiovascular Institute, Paris, France. ra@icv.org

Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension
|September 30, 2003
PubMed

Insights

Treating hypertension in older adults, including isolated systolic hypertension (ISH), significantly lowers cardiovascular risks. Treatment benefits extend to all elderly individuals, regardless of age, improving prognosis even if the blood pressure goal isn't fully met.

Area of Science:

  • Cardiology
  • Gerontology
  • Public Health

Background:

  • Elderly hypertension is mainly characterized by increased systolic blood pressure (SBP), with isolated systolic hypertension (ISH) being the most common subtype.
  • Increased large-artery stiffness is the primary hemodynamic factor in ISH, leading to elevated SBP, decreased diastolic blood pressure (DBP), and widened pulse pressure.
  • ISH and widened pulse pressure in the elderly are independent cardiovascular risk factors, potentially predicting adverse outcomes more accurately than elevated DBP alone.

Purpose of the Study:

  • To review the clinical management of hypertension in the elderly, focusing on isolated systolic hypertension (ISH).
  • To emphasize the cardiovascular benefits and prognostic improvements associated with antihypertensive treatment in older adults.
  • To highlight the importance of considering specific pathophysiological and patient characteristics in managing elderly hypertension.

Main Methods:

  • Review of epidemiological studies on hypertension in the elderly.
  • Analysis of the hemodynamic determinants of isolated systolic hypertension (ISH).
  • Evaluation of the impact of antihypertensive treatments on cardiovascular events and mortality in older populations.

Main Results:

  • Antihypertensive treatment, including for ISH, significantly reduces the risk of major coronary events, stroke, coronary heart disease, and all-cause mortality in the elderly.
  • Treatment is beneficial across all age thresholds within the elderly population.
  • A SBP reduction of 20-30 mmHg is associated with improved prognosis, even if the target blood pressure of < 140/90 mmHg is not fully achieved.

Conclusions:

  • Hypertension management in the elderly, particularly ISH, is crucial for reducing cardiovascular morbidity and mortality.
  • There is no upper age limit for considering antihypertensive treatment beneficial in older adults.
  • Clinical strategies should be tailored to the unique pathophysiology and patient characteristics of the elderly population, with partial SBP reduction offering prognostic advantages.

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