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Benefits and risks of antihypertensive medications in the elderly

D A Butt1,2, P J Harvey3

  • 1Research Institute, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.

Journal of Internal Medicine
|October 27, 2015
PubMed

Insights

Antihypertensive drug benefits in older adults are supported by trials, but risks require careful consideration. This review summarizes evidence on benefits and risks for elderly patients (aged ≥65 years).

Area of Science:

  • Gerontology
  • Cardiology
  • Pharmacology

Background:

  • Hypertension is common in older adults, contributing significantly to global cardiovascular morbidity and mortality.
  • Isolated systolic hypertension in the elderly is linked to adverse outcomes like cerebrovascular disease and acute coronary events.
  • Current international guidelines offer inconsistent recommendations for optimal blood pressure targets in elderly hypertensive patients due to limited evidence.

Purpose of the Study:

  • To comprehensively review the benefits and risks of antihypertensive drug use in elderly patients (aged ≥65 years).
  • To highlight landmark clinical trials and observational studies relevant to this population.
  • To update current evidence on specific outcomes, including cardiovascular disease, cognitive decline, and falls, to inform clinical decisions.

Main Methods:

  • Systematic review of landmark clinical trials and observational studies.
  • Focus on evidence concerning antihypertensive drug efficacy and safety in elderly populations.
  • Analysis of specific outcomes such as cardiovascular events, cognitive function, orthostatic hypotension, falls, fractures, cancer, and diabetes.

Main Results:

  • Clinical trials demonstrate benefits of antihypertensive drugs in reducing cardiovascular disease and mortality in hypertensive elderly patients.
  • Elderly participants in trials may not represent typical clinical practice patients.
  • Potential risks of antihypertensive drugs in the elderly are less studied than in younger populations.

Conclusions:

  • Antihypertensive medications offer benefits for elderly patients with hypertension, primarily in reducing cardiovascular disease.
  • Careful consideration of potential risks, including cognitive decline and falls, is crucial in this age group.
  • Further research is needed to optimize treatment strategies for hypertension in the elderly, balancing benefits and risks.

Keywords:
antihypertensive medicationsblood pressureelderlyhypertension

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