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Hypertension in the elderly: conventional wisdom revisited
1College of Pharmacy, University of Florida, Gainesville 32610.
Insights
Blood pressure in the elderly may be overstated, but risks of ignoring hypertension are similar to younger patients. Conservative blood pressure reduction is safe and effective, individualized to patient conditions.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- Elevated blood pressure in the elderly is a significant concern.
- The pathophysiology and treatment of hypertension in older adults may differ from younger populations.
- The role of plasma renin activity in elderly hypertension might be overestimated.
Purpose of the Study:
- To evaluate the significance of elevated blood pressure in the elderly.
- To assess the pathophysiology and therapeutic approaches for hypertension in older adults.
- To determine the predictive value of systolic versus diastolic pressure in adverse outcomes.
Main Methods:
- Review of existing literature on elderly hypertension.
- Analysis of pathophysiological differences in elderly hypertensive patients.
- Evaluation of therapeutic strategies, including non-pharmacologic and pharmacologic interventions.
Main Results:
- The extent of hypertension in the elderly may be overstated.
- Elevated systolic pressure is a stronger predictor of adverse events than diastolic pressure.
- Conservative reduction of blood pressure is safe and effective, with individualized therapy recommended.
Conclusions:
- Excessively elevated blood pressure is not a normal consequence of aging.
- No single antihypertensive regimen is universally optimal for all elderly patients.
- Non-pharmacologic therapy should precede judicious medication, and aggressive reduction is not advised.
Abstract:
Elevated systolic and/or diastolic blood pressure in the elderly is a problem the extent of which may be somewhat overstated. In those elderly with definite hypertension, pathophysiology may differ from that of younger counterparts. The contribution of elevated plasma renin activity to hypertension and to the choice of therapy also appears to be exaggerated. The risks of ignoring hypertension in the elderly are similar to those in younger patients, and therefore excessively elevated blood pressure should no longer be considered a normal consequence of aging. Notably, elevated systolic pressure is a better predictor of future adverse occurrences than is elevated diastolic pressure. Unfortunately, there is no well defined therapeutic regimen to manage isolated systolic hypertension. Conservative reduction of elevated systolic and diastolic pressures may nevertheless be accomplished safely and effectively. Individualization of therapy is recommended based primarily on concomitant disease(s). Thus no single agent or combination of agents is preferable in all elderly hypertensive patients. Aggressive use of non-pharmacologic therapy preferably precedes judicious of antihypertensive medication. Aggressive blood pressure reduction with potent drugs is not recommended.