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Hypertension in the elderly: a Japanese perspective
Toshio Ogihara1, Hiromi Rakugi
1Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan. ogihara@geriat.med.osaka-u.ac.jp
Drugs & Aging
|April 21, 2005
Summary
Treating hypertension in older adults requires individualized care, focusing on cautious blood pressure reduction. Management strategies include lifestyle changes and specific medications, with careful dose adjustments to avoid adverse effects.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Elderly hypertension presents unique challenges due to arteriosclerosis, isolated systolic hypertension, increased pulse pressure, and orthostatic hypotension.
- Large-scale trials confirm the necessity of treating hypertension, including isolated systolic hypertension, in older populations.
Purpose of the Study:
- To outline evidence-based strategies for managing hypertension in elderly individuals.
- To define specific blood pressure targets and treatment approaches for different age groups within the elderly population.
Main Methods:
- Review of large-scale intervention trials and established treatment guidelines for elderly hypertension.
- Discussion of nonmedical therapies, first-line antihypertensive drug classes, and combination therapy.
- Emphasis on individualized management, cautious dose titration, and monitoring for target organ hypoperfusion.
Main Results:
- Young-old (65-74) hypertensive patients are treated similarly to younger adults.
- For old-old (75-84) patients with mild hypertension, target blood pressure (BP) is <140/90 mm Hg.
- For old-old and oldest-old (>85) patients with systolic BP ≥160 mm Hg, cautious treatment with an intermediate target BP of <150 mm Hg, followed by <140 mm Hg if tolerated, is recommended.
Conclusions:
- Individualized management of nonmedical therapies is crucial to maintain quality of life.
- Diuretics, calcium channel antagonists, ACE inhibitors, and ARBs are first-line agents; combination therapy is often needed.
- Treatment requires cautious, slow BP reduction, starting with half doses and adjusting over months, prioritizing avoidance of target organ hypoperfusion.