Current approaches to the treatment of hypertension in older persons

Area of Science:

• Cardiology
• Geriatrics
• Pharmacology

Background:

• Hypertension is a primary risk factor for cardiovascular disease, affecting a majority of patients with myocardial infarction, stroke, heart failure, and peripheral arterial disease.
• Evidence supports antihypertensive drug therapy for reducing cardiovascular events in adults aged 65-79.
• The benefits of treating hypertension in the very elderly (≥ 80 years) require further investigation.

Purpose of the Study:

• To evaluate the efficacy of antihypertensive drug therapy in patients aged 80 years and older.
• To determine optimal blood pressure (BP) treatment goals for elderly populations.
• To review nonpharmacologic and pharmacologic approaches to hypertension management in older adults.

Main Methods:

• Analysis of data from the Hypertension in the Very Elderly Trial (HYVET).
• Review of existing epidemiologic and clinical trial data on BP treatment goals.
• Consideration of nonpharmacologic lifestyle interventions and various classes of antihypertensive medications.

Main Results:

• In patients aged ≥ 80 years, antihypertensive therapy led to a 30% reduction in stroke, 21% reduction in all-cause mortality, and 64% reduction in heart failure.
• Suggested BP goals: <140/90 mm Hg for <80 years, and 140-145 mm Hg systolic for ≥80 years if tolerated.
• Multiple drug classes, including diuretics, ACE inhibitors, ARBs, beta-blockers, and calcium channel blockers, demonstrated cardiovascular benefits.

Conclusions:

• Antihypertensive drug therapy is beneficial in patients aged 80 years and older, reducing stroke, mortality, and heart failure.
• Tailored BP goals and careful drug selection are crucial, considering patient age, comorbidities, and potential adverse effects.
• Nonpharmacologic lifestyle modifications are essential for both prevention and adjunctive treatment of hypertension in the elderly.