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Treatment of hypertension in patients 80 years of age or older

M F O'rourke1, M Namasivayam, A Adji

  • 1St Vincent's Clinic, University of New South Wales, Sydney, Australia. m.orourke@unsw.edu.au

Minerva Medica
|March 12, 2009
PubMed

Insights

Isolated systolic hypertension (ISH) affects most individuals over 80 due to arterial stiffening. Recent studies like HYVET support treating ISH in this age group, aligning with SHEP guidelines.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Clinical Pharmacology

Background:

  • Isolated systolic hypertension (ISH) is prevalent in individuals aged 80 and above.
  • Arterial stiffening of the aorta and large elastic arteries is a primary cause of ISH.
  • Treatment consensus for ISH in the very elderly was lacking before recent trials.

Purpose of the Study:

  • To review the background of the Systolic Hypertension in the Elderly Project (SHEP) and Hypertension in the Very Elderly Trial (HYVET) studies.
  • To explain the impact of aging on arterial stiffness and its consequences.
  • To discuss the rationale for antihypertensive therapy in older adults and propose treatment strategies.

Main Methods:

  • Review of existing literature and clinical trial data (SHEP, HYVET).
  • Analysis of physiological changes related to aging and hypertension.
  • Evaluation of antihypertensive mechanisms and their efficacy in the elderly.

Main Results:

  • The HYVET study supports applying SHEP treatment principles to most individuals over 80 with ISH.
  • Arterial stiffness significantly affects cardiovascular, cerebral, and renal health in the elderly.
  • Newer antihypertensives offer a basis for treating ISH by indirectly addressing arterial stiffness.

Conclusions:

  • Antihypertensive therapy is recommended for most individuals over 80 with ISH, based on HYVET findings.
  • Understanding arterial stiffness is crucial for managing hypertension in the very elderly.
  • Evidence-based strategies for initiating and managing antihypertensive treatment in individuals over 80 are proposed.

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