Current challenges in antihypertensive treatment in the elderly

Area of Science:

• Gerontology
• Cardiovascular Medicine
• Pharmacology

Background:

• Arterial hypertension is a prevalent condition, increasing with age and associated with arterial stiffening.
• Elevated blood pressure (BP) in the elderly correlates with heightened cardiovascular risk.
• Current guidelines recommend BP reduction to <150/90 mmHg in elderly hypertensive patients.

Purpose of the Study:

• To review the current evidence and guidelines for managing arterial hypertension in the elderly population.
• To discuss the implications of recent trials, such as SPRINT, on BP management targets in older adults.
• To highlight considerations for specific subgroups like octogenarians and frail individuals.

Main Methods:

• Systematic review of clinical trials and guideline recommendations for hypertension management in the elderly.
• Analysis of data regarding the benefits and risks of different systolic blood pressure (SBP) targets.
• Evaluation of antihypertensive drug classes efficacy and safety in older populations.

Main Results:

• Trials demonstrate significant morbidity and mortality benefits from reducing SBP to <150 mmHg in the elderly.
• The SPRINT trial suggests potential survival benefits with SBP targets of 120-125 mmHg in those >75 years.
• Concerns exist regarding aggressive BP reduction in frail elderly and nursing home residents, advocating conservative treatment.

Conclusions:

• Diuretics, calcium channel blockers, ACE inhibitors, and ARBs are effective first-line agents for elderly hypertension.
• Careful titration and monitoring are essential due to comorbidities and polypharmacy in this population.
• Further research is needed to clarify optimal BP targets for diverse elderly subgroups.