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Hypertension and the elderly
1University Department of Medicine, Glenfield Hospital, Leicester, UK.
Insights
Treating hypertension in elderly patients, especially those with systolic blood pressure over 160 mmHg, significantly reduces cardiovascular risks. Thiazide diuretics and beta-blockers are recommended first-line treatments for this population.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Cardiovascular disease is a leading cause of death in the elderly.
- Hypertension is the primary treatable risk factor for cardiovascular disease in older adults.
- There has been a lack of consensus on the assessment and treatment of hypertension in the elderly.
Purpose of the Study:
- To review the evidence for treating hypertension in elderly patients.
- To provide guidance on the assessment and management of hypertension in this demographic.
- To highlight the benefits of antihypertensive therapy in reducing cardiovascular morbidity and mortality.
Main Methods:
- Review of recent large intervention trials on blood pressure reduction in elderly hypertensive patients.
- Analysis of data regarding the efficacy of thiazide diuretics and beta-blockers.
- Consideration of treatment guidelines for elderly patients with specific blood pressure thresholds.
Main Results:
- Blood pressure reduction in elderly patients with combined and isolated systolic hypertension using thiazide diuretics or beta-blockers significantly reduces cardiovascular morbidity and mortality.
- The STOP-Hypertension Trial demonstrated a reduction in total mortality with active treatment.
- Patients under 80 with SBP ≥ 160 mmHg and DBP ≥ 90 mmHg or SBP ≥ 160 mmHg and DBP < 90 mmHg should be considered for antihypertensive therapy.
Conclusions:
- Negative attitudes towards treating hypertension in the elderly are no longer justifiable.
- Thiazide diuretics and beta-blockers are established first-line pharmacological therapies.
- Long-term benefits of other antihypertensive agents require further assessment; benefits in certain subgroups remain unproven.
Abstract:
Cardiovascular disease remains the major cause of death in elderly people, with hypertension the main treatable risk factor. Despite this there has been little consensus with regard to assessment or treatment of the elderly hypertensive patient. Several recent large intervention trials have shown blood pressure (BP) reduction in elderly patients with combined and isolated systolic hypertension using thiazide diuretics or beta-blockers significantly reduces cardiovascular morbidity and mortality. However, only the STOP-Hypertension Trial has shown a reduction in total mortality with active treatment. Patients under 80 years with an SBP > or = 160 mmHg and DBP > or = 90 mmHg or SBP > or = 160 mmHg and DBP < 90 mmHg should be considered for anti-hypertensive therapy, initially using non-pharmacological methods. Thiazide diuretics and beta-blockers remain first-line pharmacological therapy, the long-term benefits of other types of anti-hypertensive agent have yet to be assessed. In general the negative attitudes to treating hypertension in the elderly can no longer be upheld, although in certain sub-groups the benefits of treatment are as yet unproven.