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Managing Hypertension in the elderly: What's new?

Wilbert S Aronow1

  • 1Departments of Medicine and Cardiology, Westchester Medical Center and New York Medical College, Macy Pavilion, Room 141, 10595, Valhalla, NY, USA.

American Journal of Preventive Cardiology
|July 30, 2021
PubMed

Insights

Hypertension management in older adults requires personalized care. Clinical judgment is key for frail elderly patients, but more trials are needed for this population.

Area of Science:

  • Cardiology
  • Geriatrics
  • Clinical Pharmacology

Background:

  • Hypertension is a leading modifiable risk factor for cardiovascular disease and mortality globally.
  • In the elderly, hypertension significantly increases cardiovascular event risk.
  • The 2017 ACC/AHA guidelines recommend treating systolic blood pressure (SBP) <130 mmHg in adults aged 65+.

Purpose of the Study:

  • To review current recommendations for hypertension management in the elderly.
  • To highlight the need for tailored treatment strategies in frail elderly individuals.
  • To identify gaps in clinical trial data for specific elderly subpopulations.

Main Methods:

  • Review of the 2017 ACC/AHA hypertension guidelines.
  • Discussion of clinical considerations for managing hypertension in elderly patients with comorbidities.
  • Identification of areas requiring further research, particularly in frail and older populations.

Main Results:

  • Current guidelines recommend SBP <130 mmHg for community-dwelling elderly.
  • Clinical judgment and patient-centered approaches are crucial for frail elderly with comorbidities and limited life expectancy.
  • Significant gaps exist in evidence for hypertension treatment in nursing home residents, those over 85, and frail individuals.

Conclusions:

  • Personalized treatment decisions are essential for elderly hypertensive patients, balancing benefits and risks.
  • Randomized clinical trials are urgently needed in frail elderly populations, including nursing home residents and those with multiple comorbidities.
  • Further research should investigate the impact of various antihypertensive drugs on clinical outcomes and adverse events in diverse elderly groups.

Keywords:
Diastolic blood pressureElderlyHypertensionSystolic blood pressure

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