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[Resistant hypertension in the elderly.]
Paolo Cicconetti1, Alessandra Di Berardino1, Maria Tortorelli D'Ambrosio1
1Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, Sapienza Università di Roma.
Recenti Progressi in Medicina
|August 29, 2017
Summary
Resistant hypertension in older adults lacks prevalence studies, but it increases cardiovascular risk. Differentiating true resistance from pseudoresistance and optimizing treatment are crucial for better outcomes.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Epidemiology
Background:
- Limited epidemiological data exists on resistant hypertension prevalence in the elderly population.
- The National Health and Nutrition Examination Survey reported 12.8% prevalence in the adult population.
- Pseudoresistance in elderly patients can stem from white coat hypertension, arterial stiffness, poor compliance, high salt intake, NSAID use, or secondary hypertension.
Purpose of the Study:
- To highlight the diagnostic challenges and cardiovascular risks associated with resistant hypertension in the elderly.
- To emphasize the importance of excluding pseudoresistance before diagnosing true resistant hypertension.
- To discuss current and emerging therapeutic strategies for managing resistant hypertension in older adults.
Main Methods:
- Review of existing literature and epidemiological survey data.
- Clinical assessment to differentiate true resistant hypertension from pseudoresistance.
- Evaluation of current and experimental pharmacological and non-pharmacological treatments.
Main Results:
- True resistant hypertension significantly elevates cardiovascular risk in the elderly.
- Exclusion of pseudoresistance factors is critical for accurate diagnosis and effective management.
- Current treatment guidelines emphasize lifestyle adherence and specific pharmacological agents.
Conclusions:
- Accurate diagnosis of resistant hypertension in the elderly requires careful exclusion of pseudoresistance.
- Optimizing therapy with agents like renin-angiotensin system blockers, dihydropyridine calcium channels, or aldosterone antagonists is essential.
- Emerging treatments such as renal denervation and baroreflex stimulation show promise for future management.
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