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A practical approach to the pharmacological management of hypertension in older people

Nikesh Parekh1, Amy Page2, Khalid Ali1

  • 1Brighton and Sussex Medical School, Brighton, UK.

Therapeutic Advances in Drug Safety
|April 26, 2017
PubMed

Insights

Managing hypertension in older adults requires careful consideration of guidelines and age-related challenges. This paper offers a new algorithm for safe antihypertensive medication use in elderly patients with multiple health conditions.

Area of Science:

  • Gerontology
  • Cardiology
  • Pharmacology

Background:

  • Hypertension is a primary driver of cardiovascular disease in adults over 65.
  • Managing hypertension in older adults presents unique challenges due to aging-related conditions.

Purpose of the Study:

  • To summarize current European and US guidelines for pharmacological hypertension management in older adults.
  • To discuss challenges in managing hypertension amidst multimorbidity, frailty, and cognitive decline in the elderly.
  • To introduce a novel algorithm for safe antihypertensive prescribing in complex older patients.

Main Methods:

  • Review of current hypertension management guidelines for older adults in Europe and the USA.
  • Analysis of evidence from key clinical trials informing these guidelines.
  • Development of a new algorithm ('BEGIN') for guiding antihypertensive therapy initiation and management in older adults.

Main Results:

  • Current guidelines provide a framework for hypertension treatment in older populations.
  • Multimorbidity, frailty, orthostatic hypotension, falls, and cognitive impairment complicate hypertension management.
  • The proposed 'BEGIN' algorithm offers a structured approach to safe medication use.

Conclusions:

  • Effective hypertension management in older adults necessitates adherence to guidelines while addressing age-specific complexities.
  • The 'BEGIN' algorithm provides a practical tool for prescribers to optimize antihypertensive therapy and decision-making in elderly patients.
  • Rational treatment and monitoring, including considering drug withdrawal, are crucial for complex older individuals.

Keywords:
hypertensionmedicines optimizationmultimorbidityolder adults

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