Managing Hypertension in Older Adults.

Area of Science:

• Gerontology and Cardiovascular Medicine
• Public Health and Epidemiology

Background:

• Global populations of older adults (60-79 and ≥80 years) are rapidly increasing.
• Cardiovascular event risk escalates with age and elevated systolic blood pressure, highlighting the need for effective hypertension management.
• Hypertension disproportionately affects older women, presenting a significant women's health concern.

Purpose of the Study:

• To review the critical role of hypertension management in older adults.
• To analyze the benefits and risks of intensive blood pressure control in different age groups and frailty levels.
• To emphasize the importance of functional and cognitive assessments in tailoring hypertension treatment targets.

Main Methods:

• Review of current literature on hypertension in aging populations.
• Comparative analysis of cardiovascular event rates and adverse events associated with varying blood pressure control intensities.
• Evaluation of the impact of frailty and cognitive function on treatment efficacy.

Main Results:

• Older adults (≥80 years) experience greater absolute benefits from hypertension control than younger older adults (60-79 years).
• While adverse events increase with age, intensive therapy shows only a moderate excess risk compared to standard care.
• Benefits of intensive therapy diminish or reverse in frail older adults (≥80 years) with significant cognitive impairment.

Conclusions:

• Hypertension management is essential for mitigating cardiovascular disease burden in the growing elderly population.
• Tailored blood pressure targets, informed by functional and cognitive status, are crucial for older adults.
• Shared decision-making regarding hypertension targets is recommended for independent-living older adults due to substantial cardiovascular benefits.