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[Treatment of arterial hypertension in the elderly person: unresolved problems]

U Scherrer1

  • 1Policlinique médicale universitaire, Lausanne.

Schweizerische Rundschau Fur Medizin Praxis = Revue Suisse De Medecine Praxis
|August 28, 1990
PubMed

Insights

Treating diastolic hypertension in the elderly offers limited cardiovascular risk reduction. Ambulatory blood pressure monitoring can improve patient selection, reducing overtreatment and side effects for older adults.

Area of Science:

  • Cardiology
  • Geriatrics
  • Epidemiology

Context:

  • Hypertension management in elderly populations presents challenges regarding cardiovascular risk reduction.
  • Individual absolute risk reduction from treatment is often modest.
  • Epidemiological data suggest limited population-level benefit.

Purpose:

  • To evaluate the epidemiological evidence for cardiovascular risk reduction in elderly patients with diastolic hypertension.
  • To advocate for improved patient selection strategies in hypertension management.
  • To minimize overtreatment and associated adverse effects.

Summary:

  • Current evidence indicates that treating diastolic hypertension in the elderly yields minimal significant cardiovascular risk reduction at a population level.
  • Ambulatory blood pressure monitoring (ABPM) is recommended to accurately diagnose hypertension and identify white coat hypertension, thereby optimizing treatment decisions.
  • This approach aims to identify elderly hypertensive patients most likely to benefit from pharmacological intervention, reducing unnecessary treatment and potential side effects.

Impact:

  • Widespread adoption of ABPM can lead to more precise patient selection for antihypertensive therapy in older adults.
  • Reduced overtreatment can decrease medication-related side effects, including coronary morbidity and mortality.
  • Optimized treatment strategies enhance the benefit-risk ratio for elderly patients with hypertension.

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