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Hypertension: how does management change with aging?

Milta O Little1

  • 1Division of Gerontology and Geriatric Medicine, Department of Internal Medicine, Saint Louis University School of Medicine, 1402 South Grand Boulevard, Room M238, St Louis, MO 63139, USA. mlittle6@slu.edu

The Medical Clinics of North America
|May 10, 2011
PubMed

Insights

For older adults, managing hypertension is crucial for reducing cardiovascular risks. The best approach involves age-adjusted blood pressure goals and initiating treatment with thiazide diuretics or ACE inhibitors when systolic pressure exceeds 160/90 mmHg.

Area of Science:

  • Gerontology
  • Cardiology
  • Internal Medicine

Background:

  • Hypertension in individuals over 60 is a major contributor to cardiovascular disease, morbidity, and mortality.
  • Isolated systolic hypertension and pulse pressure are key indicators, potentially more significant than diastolic hypertension.
  • Orthostatic hypotension and very low blood pressure are linked to increased mortality and require regular monitoring.

Purpose of the Study:

  • To review the evidence-based management of hypertension in older adults.
  • To define optimal blood pressure targets and initial therapeutic strategies for this demographic.

Main Methods:

  • Review of current best evidence and clinical guidelines.
  • Analysis of risk factors, including isolated systolic hypertension and orthostatic hypotension.
  • Evaluation of therapeutic interventions and their impact on outcomes.

Main Results:

  • Elevated blood pressure, specifically greater than 160/90 mmHg, necessitates treatment for improved outcomes.
  • Age-adjusted blood pressure goals are recommended for older populations.
  • Thiazide diuretics are identified as the first-line therapy, with angiotensin-converting enzyme inhibitors as a viable alternative.

Conclusions:

  • Tailoring hypertension management to age is essential for older adults.
  • Early intervention with appropriate pharmacotherapy, such as thiazide diuretics or ACE inhibitors, can mitigate cardiovascular risks.
  • Regular assessment for hypotension is critical in elderly patients.

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