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Update on pathophysiology and treatment of hypertension in the elderly

Debbie L Cohen1, Raymond R Townsend

  • 1Renal, Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, USA. debbie.cohen@uphs.upenn.edu

Current Hypertension Reports
|June 18, 2011
PubMed

Insights

Hypertension is prevalent in older adults due to aging vascular systems and arterial stiffness. A blood pressure goal of 150/80-90 mmHg is recommended for the elderly, with specific medication guidelines provided.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Hypertension is highly prevalent in the elderly, increasing with age.
  • Arterial stiffness, a hallmark of vascular aging, significantly contributes to hypertension in older individuals.
  • Aging-related changes in nitric oxide and angiotensin II pathways are critical to vascular aging and hypertension.

Purpose of the Study:

  • To review landmark hypertension studies in the elderly.
  • To discuss the pathophysiology of increased arterial stiffness in aging.
  • To provide evidence-based recommendations for blood pressure goals and pharmacotherapy in elderly hypertensive patients.

Main Methods:

  • Review of landmark clinical trials and outcome data concerning hypertension in the elderly.
  • Analysis of studies measuring vascular stiffness and its relationship to aging.
  • Synthesis of current guidelines and expert opinions on managing hypertension in older adults.

Main Results:

  • A reasonable target blood pressure for the very elderly is 150/80-90 mmHg, based on current outcome data.
  • Direct measures of vascular stiffness have enhanced understanding of age-related hypertension.
  • Specific age-related changes in vascular pathways contribute to hypertension.

Conclusions:

  • Thiazide diuretics, long-acting calcium channel blockers, and ACE inhibitors/ARBs are recommended for elderly hypertension management.
  • Beta-blockers should be reserved for specific indications in this population.
  • Individualized treatment strategies are essential for managing hypertension in the elderly.

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