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Hypertension in the frail elderly
Barry J Materson1, Manuel Garcia-Estrada2, Richard A Preston3
1Division of Clinical Pharmacology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Journal of the American Society of Hypertension : JASH
|April 28, 2016
Summary
Lowering systolic pressure benefits younger and healthy older adults. However, frail elderly hypertensives require individualized treatment, as they may benefit less from drug therapy.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Current data support treating younger individuals and healthy octogenarians to lower systolic pressure.
- Limited evidence exists for managing hypertension in frail elderly patients.
- Chronological age alone is insufficient for therapeutic decisions in older adults.
Purpose of the Study:
- To review current evidence on antihypertensive treatment in older adults.
- To differentiate treatment strategies for robust versus frail elderly patients.
- To inform clinical practice regarding hypertension management in the elderly.
Main Methods:
- Review of existing clinical data and studies on hypertension treatment in the elderly.
- Discussion of frailty assessment methods (questionnaires, walking speed).
- Analysis of benefits and risks of antihypertensive drug therapy in different elderly subgroups.
Main Results:
- Robust older patients generally benefit from antihypertensive treatment, similar to younger patients.
- Frail elderly individuals, despite higher cardiovascular risk, show less benefit or no benefit from drug treatment.
- Individualized treatment is crucial for frail elderly patients; some may benefit from elevated systolic pressures.
Conclusions:
- Antihypertensive therapy should continue for individuals over 80 if already successful.
- Treatment decisions for the frail elderly must be individualized, considering potential risks and benefits.
- Early prevention of hypertension in middle age is key for mitigating later cognitive dysfunction.
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