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[Treatment of arterial hypertension in elderly patients. Value and indications]
P Bert1, F Forette, A S Rigaud
1Service de Gérontologie clinique, Hôpital Broca, Paris.
Insights
Treating high blood pressure in older adults, including isolated systolic hypertension, reduces cardiovascular risks and mortality. Effective management of hypertension in the elderly is crucial for better health outcomes.
Area of Science:
- Gerontology
- Cardiology
- Neurology
Context:
- Hypertension prevalence increases with age, posing significant risks for elderly individuals.
- Elderly hypertension is linked to cardiovascular diseases and vascular dementia.
- Mortality data in hypertensive elderly subjects up to age 90 indicates increased risk.
Purpose:
- To evaluate the benefits of treating different types of hypertension in the elderly.
- To assess the impact of antihypertensive therapies on cardiovascular events and mortality.
- To investigate the effect of hypertension treatment on vascular dementia.
Summary:
- Distinguishes between systolo-diastolic hypertension and isolated systolic hypertension.
- European studies (EWPHE, MRC) show benefits of treating systolo-diastolic hypertension, reducing cardiovascular mortality and morbidity.
- Studies like SHEP and Syst-Eur investigate the benefits of treating isolated systolic hypertension, including its effect on cerebral vascular events and vascular dementia.
Impact:
- Active treatment of hypertension in the elderly significantly lowers cardiovascular disease mortality and morbidity.
- Therapeutic interventions reduce risks of myocardial infarction, left ventricular failure, and cerebral vascular events.
- Ongoing research aims to confirm benefits for isolated systolic hypertension and its specific impact on vascular dementia in older adults.
Abstract:
The prevalence of high blood pressure increases with age and, in elderly subjects, it is a major risk factor not only for cardiovascular diseases but also for other diseases including vascular dementia. Data concerning mortality are more controversial, but it is known that up to the age of 90, mortality is increased in hypertensive subjects. Two pathological conditions can be distinguished, systolo-diastolic hypertension with a systolic pressure above 160 mmHg and diastolic pressure above 95 mmHg and systolic hypertension alone when the systolic pressure is above 160 mmHg and diastolic below 95 (or 90) mmHg. The European working party on high blood pressure in the elderly (EWPHE) and the Medical Research Council trial of treatment of hypertension in older adults have demonstrated the beneficial effect of treating systolo-diastolic hypertension. Active therapy significantly reduces the risk of mortality due to cardiovascular disease, notably myocardial infarction, and in morbidity due to left ventricular failure and non-mortal cerebral vascular events. The current debate centers on the pressure level which should be attained, especially in patients with a history of ischaemic cardiopathy. Treatment of elderly patients with systolic hypertension alone is also probably beneficial, although only the systolic hypertension in the elderly program (SHEP) was able to demonstrate a significant reduction in cerebral vascular events and in the incidence of myocardial infarction, even in subjects over 80. A multicentric European study (Syst-Eur), which includes patients treated with calcium inhibiteurs and conversion enzyme inhibiteurs, is being conducted in order to confirm the beneficial effect of treating systolic hypertension in subjects over 60. In addition, this study also includes a complementary project specifically designed to evaluate the effect of treatment on vascular dementia.