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Hypertension treatment for older people-navigating between Scylla and Charybdis
Simon Paul Conroy1, Rudi Gerardus Johannes Westendorp2,3, Miles D Witham4
1Department of Health Sciences, University of Leicester School of Medicine, Centre for Medicine University of Leicester Lancaster Road, Leicester, United Kingdom of Great Britain and Northern Ireland.
Insights
Managing hypertension in older adults requires considering multiple health conditions, frailty, and dementia. This approach differs from isolated management often suggested by clinical evidence, emphasizing personalized care strategies.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- Hypertension is prevalent in older adults, frequently co-occurring with other conditions like frailty and dementia.
- Real-world management of hypertension in the elderly often deviates from evidence-based guidelines due to multiple comorbidities.
- Ageing-related factors significantly impact blood pressure control and treatment efficacy.
Purpose of the Study:
- To discuss the complexities of hypertension management in the context of ageing, frailty, and dementia.
- To review the existing evidence base for treating hypertension in older populations.
- To explore innovative therapeutic strategies and shared decision-making models for elderly patients.
Main Methods:
- Literature review of studies on hypertension in older adults.
- Analysis of the impact of ageing, frailty, and dementia on blood pressure management.
- Exploration of therapeutic options and shared decision-making principles.
Main Results:
- Evidence-based hypertension management often overlooks the multifactorial nature of health in older, frail individuals.
- Ageing, frailty, and dementia necessitate tailored approaches to blood pressure control.
- Shared decision-making can enhance treatment adherence and outcomes in this population.
Conclusions:
- Hypertension treatment in older adults must integrate considerations of ageing, frailty, and dementia.
- A holistic and individualized approach, including shared decision-making, is crucial for effective blood pressure management.
- Future strategies should bridge the gap between clinical trial evidence and real-world geriatric care.
Abstract:
Hypertension is a common condition in older people, but is often one of many conditions, particularly in frail older people, and so is rarely managed in isolation in the real world-which belies the bulk of the evidence upon which is treatment decisions are often based. In this article, we discuss the issues of ageing, including frailty and dementia, and their impact upon blood pressure management. We examine the evidence base for managing hypertension in older people, and explore some therapeutic ideas that might influence treatment decisions and strategies, including shared decision making.
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