Rational Prescribing and Deprescribing of Antihypertensive Medications in Older People, Part 2

Area of Science:

• Gerontology
• Cardiovascular Medicine
• Clinical Pharmacology

Background:

• Strong evidence supports blood pressure (BP) control in healthy older adults for reducing morbidity and mortality.
• Historical debate exists regarding intensive hypertension treatment in older populations, informed by randomized controlled trials (RCTs) and observational studies.
• Early studies indicated a J-shaped curve for mortality, suggesting a risk associated with overly low BP levels.

Purpose of the Study:

• To evaluate the nuances of BP targets in older adults, considering varying health statuses.
• To address the exclusion of complex and frail older individuals from pivotal BP control trials.
• To determine if current BP targets are appropriate for all older adult populations.

Main Methods:

• Review of epidemiological studies and randomized controlled trials (RCTs) on hypertension management in older adults.
• Analysis of cohort studies focusing on complex and frail older populations.
• Examination of the concept of "too low" BP and its implications for different geriatric subgroups.

Main Results:

• While BP control is beneficial for robust older adults, a "too low" BP threshold may exist and vary.
• Complex and frail older individuals, often excluded from RCTs, may have different optimal BP targets.
• The decision to initiate or discontinue BP-lowering medication requires careful consideration of individual patient factors.

Conclusions:

• Individualized BP management is crucial for older adults, accounting for frailty and comorbidities.
• Current generalized BP targets may not be suitable for all elderly patients, particularly the frail.
• Further research is needed to establish tailored BP guidelines for diverse older adult populations.