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[Treatment of hypertension in the elderly]
A Moan1, S E Kjeldsen, G Nordby
1Medisinsk klinikk, Ullevl sykehus, Oslo.
Insights
Treating hypertension in elderly patients, especially isolated systolic hypertension, shows cardiovascular benefits. Pharmacological intervention is recommended for diastolic blood pressure over 100mm Hg or systolic pressure exceeding (100 + age) mm Hg.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Context:
- Limited data exists on treating hypertension in the elderly (60-65+ years).
- Isolated systolic hypertension in this demographic requires further investigation.
- Recent studies indicate positive cardiovascular outcomes from hypertension treatment in older adults.
Purpose:
- To review and suggest guidelines for managing hypertension in the elderly.
- To define thresholds for initiating pharmacological treatment based on blood pressure readings and age.
- To highlight effective antihypertensive drug classes.
Summary:
- Suggests treating diastolic blood pressure >100mm Hg after 3-6 months of observation.
- Recommends pharmacological treatment for systolic blood pressure >(100 + age) mm Hg in essential hypertension without comorbidities.
- Diuretics and beta-blockers are currently the most evidence-based treatments for reducing cardiovascular events.
Impact:
- Provides a framework for clinical decision-making in elderly hypertension management.
- Emphasizes the importance of considering both systolic and diastolic pressures in older patients.
- Underscores the need for more research on other antihypertensive agents in this population.
Abstract:
The effect of treating hypertension in the elderly (aged 60-65 years and above), and isolated systolic hypertension in particular, has not been adequately documented. In three recent studies, however, a good effect in respect of cardiovascular end points has been observed in this group of patients. We have previously suggested pharmacological treatment of a diastolic blood pressure above 100mm Hg after three to six months' observation and non-pharmacological intervention. In a patient with essential hypertension, and with no concomitant disease, systolic blood pressure should also be taken into account, and when this exceeds (100 + age) mm Hg after the same period of observation the patient should be treated pharmacologically. If a patient shows additional indications for treatment of high blood pressure, the level for initiating treatment may be lower. As of today, diuretics and beta-blockers have proven effective in reducing cardiovascular morbidity and mortality, while data on the other antihypertensive agents are still lacking.