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Perspective on hypertension in the elderly
1Division of Internal Medicine, University of Colorado Health Sciences Center, Denver.
Insights
Elderly hypertension significantly increases health risks. Treatment, especially antihypertensive therapy, is recommended for most older adults to reduce cardiovascular events and mortality.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Hypertension affects over 50% of elderly individuals, posing significant morbidity and mortality risks.
- The etiology of hypertension in the elderly remains unclear, often coexisting with left ventricular hypertrophy and diastolic dysfunction.
- While isolated systolic hypertension's treatment benefits are debated, evidence supports antihypertensive therapy for those up to age 80.
Purpose of the Study:
- To review the current understanding of hypertension in the elderly.
- To discuss the risks and benefits of treating hypertension in older adults.
- To outline considerations for pharmacologic management in this population.
Main Methods:
- Literature review of studies on elderly hypertension, cardiovascular disease, and antihypertensive treatments.
- Analysis of factors influencing treatment decisions, including comorbidities and drug interactions.
- Consideration of age-related changes in drug metabolism and efficacy.
Main Results:
- Antihypertensive treatment in the elderly (up to age 80) is associated with reduced cardiovascular morbidity and mortality.
- Nonpharmacologic therapy may be suitable for mild cases without cardiovascular disease, but drug therapy is often necessary.
- Age-related alterations in drug metabolism and potential drug interactions require careful medication selection.
Conclusions:
- Most elderly hypertensive patients warrant antihypertensive treatment to mitigate cardiovascular risks.
- Treatment selection must account for comorbidities, potential drug interactions, altered pharmacokinetics, and patient-specific factors like cost and convenience.
- Further research into the specific causes and optimal management strategies for hypertension in the aging population is needed.
Abstract:
More than half of elderly men and women have hypertension, leading to a significant risk of increased morbidity and mortality. The cause of hypertension in this age group is unknown. Left ventricular hypertrophy is frequently present, often associated with diastolic dysfunction. Systolic hypertension in the elderly increases the risk of cardiovascular disease, but there are no good data to show that the treatment of isolated systolic hypertension reduces the morbidity or mortality. Good evidence indicates that antihypertensive treatment in this group decreases cardiovascular morbidity and mortality up to age 80, so most elderly hypertensive patients should be treated. An empiric trial of nonpharmacologic therapy can be initiated in those with mild hypertension and no cardiovascular disease, but most patients will require drug therapy. Most elderly hypertensive patients have accompanying illnesses for which they may or may not be taking medications. Some antihypertensive drugs exacerbate coexisting diseases while others augment treatment regimens. Similarly, drugs may interact in a beneficial or adverse way. Finally, drug metabolism is altered by age, leading to problems with toxicity or diminished efficacy. The choice of medication should be based on all such considerations, including the cost and convenience of the drugs available.