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Risks associated with intensive blood pressure control in older patients
Giulia Rivasi1, Ludovica Ceolin2, Marco Capacci2
1Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy. giulia.rivasi@unifi.it.
Kardiologia Polska
|March 31, 2023
Summary
Intensive blood pressure (BP) control in older adults offers cardiovascular benefits but may increase risks like falls and cognitive decline. Careful consideration of individual health status is crucial for safe hypertension management.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Hypertension management is key for cardiovascular prevention, with established benefits of blood pressure (BP) lowering in older adults.
- Intensive BP control shows promise for reducing cardiovascular and mortality risks, even in advanced age.
- However, older adults, particularly those who are frail, may experience increased adverse events with intensive treatment, altering the risk/benefit ratio.
Approach:
- This narrative review synthesizes current evidence on the risks of intensive BP control in the elderly.
- It highlights how advanced age, frailty, and comorbidities influence treatment safety.
- The review examines safety concerns beyond syncope and falls, including effects on renal function, cognition, and quality of life.
Key Points:
- Older adults may face a higher risk of hypotension and adverse effects from aggressive BP lowering.
- Clinical trials may underestimate harms due to exclusion of frail or multimorbid patients.
- Potential harms include negative impacts on renal function, cognitive performance, quality of life, and survival.
Conclusions:
- Aggressive BP lowering in older adults requires careful risk-benefit assessment, especially in those with poor health status.
- Awareness of potential harms is vital for optimizing hypertension management in this population.
- Further clinical research focusing on the safety of intensive BP control in older, frail individuals is warranted.
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