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Hypertension in older people: part 2
1Heart Disease Prevention Program, University of California, Irvine, 92697, USA. ssfranklinmd@earthlink.net
Journal of Clinical Hypertension (Greenwich, Conn.)
|July 20, 2006
Summary
Treating isolated systolic hypertension (ISH) in older adults reduces cardiovascular events. Effective control, often requiring multiple medications, is crucial for managing arterial stiffness and improving health outcomes in the elderly.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Isolated systolic hypertension (ISH) is prevalent in the elderly, characterized by elevated systolic blood pressure (>or=140 mm Hg) and normal diastolic blood pressure (<90 mm Hg).
- ISH in older adults is primarily linked to increased large artery stiffness, making it challenging to manage compared to younger individuals with diastolic hypertension.
- Despite evidence of reduced cardiovascular events and improved longevity, ISH treatment in the elderly remains suboptimal, with a low percentage achieving target blood pressure goals.
Purpose of the Study:
- To emphasize the critical importance of controlling isolated systolic hypertension (ISH) in the elderly due to the increased risk of vascular events.
- To highlight the specific challenges in managing ISH in older populations, particularly those related to arterial stiffness.
- To advocate for appropriate lifestyle and pharmacologic interventions for ISH management in elderly individuals, including those with diabetes or chronic kidney disease.
Main Methods:
- Review of existing evidence on the pharmacologic treatment of isolated systolic hypertension (ISH) in the elderly.
- Analysis of the relationship between arterial stiffness and hypertension control in different age groups.
- Assessment of current treatment patterns and goal achievement rates for ISH in older patients.
Main Results:
- Pharmacologic treatment of ISH significantly reduces cardiovascular events and extends longevity in the elderly, with proven benefits for stroke and heart failure reduction in the very old.
- ISH in the elderly, driven by arterial stiffness, is more difficult to control than diastolic hypertension in younger individuals.
- Achieving target systolic blood pressure levels in older adults frequently necessitates polypharmacy, including diuretics and agents targeting arterial stiffness.
Conclusions:
- Controlling isolated systolic hypertension (ISH) is essential for reducing cardiovascular risk and improving outcomes in the elderly.
- Effective management of ISH in older adults requires addressing underlying arterial stiffness and often involves a combination of lifestyle modifications and multiple antihypertensive medications.
- Increased awareness and improved treatment strategies are needed to ensure more elderly patients with ISH achieve their blood pressure goals.
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