Related Experiment Videos
Hypertension in the elderly
1Department of Pharmacology, University of Saskatchewan, Saskatoon.
Insights
High blood pressure in older adults is common and increases health risks. Treating hypertension in the elderly, including isolated systolic hypertension, offers significant benefits and outweighs potential harms.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Forty percent of Canadians over 65 have high blood pressure (hypertension), increasing risks of stroke, heart failure, heart attack, and death.
- Aging involves circulatory changes like increased vascular resistance and decreased cardiac output, contributing to hypertension.
- Elderly hypertensives experience similar treatment benefits as younger individuals.
Purpose of the Study:
- To review the risks and benefits of treating hypertension in individuals over 65.
- To evaluate treatment strategies for both systolic-diastolic and isolated systolic hypertension in the elderly.
- To highlight considerations for antihypertensive drug selection and potential interactions in older adults.
Main Methods:
- Review of major clinical trials on hypertension treatment, including subsets of elderly patients.
- Analysis of specific trials focused on elderly hypertensive populations.
- Examination of drug classes, contraindications, and potential adverse effects in elderly patients.
Main Results:
- Treatment of systolic-diastolic hypertension in the elderly provides benefits that outweigh harms.
- Isolated systolic hypertension is a significant risk factor, comparable to systolic-diastolic hypertension.
- Thiazides are effective but contraindicated in many elderly patients; calcium channel blockers offer an alternative.
Conclusions:
- Hypertension management in the elderly is crucial for reducing cardiovascular events.
- Careful drug selection and monitoring for interactions and rapid blood pressure reduction are essential.
- Further research is needed on the definitive impact of treating isolated systolic hypertension on mortality and morbidity.
Abstract:
As many as forty percent of Canadians over age sixty-five have blood pressure readings of 160/90 or higher. They are at greater risk for stroke, congestive heart failure, myocardial infarction and sudden death. Hypertension appears to be an exaggeration of the normal circulatory changes of aging--increased systemic vascular resistance and a slight decrease in cardiac output at rest and during exercise. The major trials of treatment for hypertension have included subsets of elderly hypertensives who have enjoyed about the same overall benefit from treatment as younger subjects. Two treatment trials specifically for elderly hypertensives also show that treating systolic-diastolic hypertension does more good than harm. Isolated systolic hypertension appears to be a risk factor of equal magnitude to systolic/diastolic hypertension. Although it is possible to treat isolated systolic hypertension, the definitive clinical trial comparing mortality and morbidity in treated and untreated groups is not yet published. Thiazides, while inexpensive and effective antihypertensives for the elderly, are relatively contraindicated in as many as half. Other classes of drugs, particularly calcium channel blockers, can be effective alternatives. Many, if not most, elderly hypertensives will be prescribed more than one type of antihypertensive in addition to other types of drugs. The possibility of drug interactions as well as the danger of overly rapid blood pressure reduction must be kept in mind.