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Office management of hypertension in older persons

Wilbert S Aronow1

  • 1Department of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Valhalla, USA. wsaronow@aol.com

The American Journal of Medicine
|May 25, 2011
PubMed

Insights

Antihypertensive drug therapy significantly reduces cardiovascular events and mortality in individuals aged 80 and older. Treatment aims to lower blood pressure, with specific goals for those with diabetes or chronic kidney disease.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Hypertension is a prevalent condition in older adults.
  • Effective management of hypertension is crucial for reducing cardiovascular morbidity and mortality.
  • Previous studies have focused on younger populations, leaving a gap in understanding treatment efficacy in the very elderly.

Purpose of the Study:

  • To evaluate the impact of antihypertensive drug therapy on cardiovascular events in individuals aged 80 years and older.
  • To determine target blood pressure goals for hypertension management in the elderly, including those with comorbidities.
  • To assess the comparative effectiveness of different antihypertensive drug classes in older populations.

Main Methods:

  • Analysis of data from the Hypertension in the Very Elderly Trial (HYVET) with a 1.8-year follow-up period.
  • Inclusion of patients aged 80 years and older with a diagnosis of hypertension.
  • Review of meta-analyses comparing various antihypertensive drug classes for blood pressure reduction and cardiovascular protection.

Main Results:

  • Antihypertensive therapy led to a 30% reduction in fatal or nonfatal stroke and a 64% reduction in heart failure.
  • Significant reductions were observed in all-cause mortality (21%) and cardiovascular death (23%).
  • Key drug classes like thiazide diuretics, ACE inhibitors, and CCBs showed comparable efficacy in blood pressure lowering and cardiovascular protection.

Conclusions:

  • Antihypertensive drug therapy is effective in reducing cardiovascular events and mortality in very elderly individuals.
  • Target blood pressure should be <140/90 mm Hg for older persons and <130/80 mm Hg for those with diabetes or CKD.
  • Treatment selection should consider individual medical conditions, and combination therapy may be necessary if blood pressure is significantly above goal.

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