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Hypertension in the elderly
1Health Sciences Centre, Lund University, Dalby, Sweden.
Insights
Treating high blood pressure in elderly patients aged 70 and above significantly reduces cardiovascular disease (CVD) and stroke. Blood pressure lowering therapy is recommended for hypertensives up to age 80, considering comorbidities.
Area of Science:
- Gerontology
- Cardiology
- Clinical Pharmacology
Background:
- Cardiovascular disease (CVD) risk associated with hypertension is well-established in younger elderly (<70-75).
- Early studies suggested but did not confirm CVD risk reduction from treating hypertension in the elderly.
- The risk-benefit profile of hypertension treatment in older individuals requires clarification.
Purpose of the Study:
- To evaluate the efficacy and safety of antihypertensive drug treatment in elderly patients (aged 70 and above).
- To determine the impact of blood pressure lowering therapy on cardiovascular morbidity and mortality in the elderly.
Main Methods:
- Review of major clinical trials including the European Working Party on High Blood Pressure in the Elderly (EWPHE), The Randomised Trial of the Treatment of Hypertension in Elderly Patients in Primary Care (HEP), Systolic Hypertension in the Elderly Program (SHEP), Swedish Trial in Old Patients with Hypertension (STOP), and Medical Research Council (MRC) trials.
- Analysis of data on drug tolerability (beta-blockers and diuretics) and clinical outcomes.
Main Results:
- Major trials confirmed the benefits of treating hypertension in the elderly up to age 70-74.
- Subsequent trials including older patients and those with isolated systolic hypertension corroborated these findings.
- Drug treatment with beta-blockers and diuretics demonstrated significant reductions in cardiovascular events, particularly stroke, without significant tolerability issues.
Conclusions:
- Antihypertensive drug treatment, specifically with beta-blockers and diuretics, offers significant and clinically relevant reductions in cardiovascular morbidity and mortality in hypertensive individuals aged 70 and older.
- Blood pressure lowering therapy should be considered for elderly hypertensives up to age 80.
- Treatment plans must be individualized, accounting for potential comorbidities common in elderly patients.
Abstract:
Several studies have demonstrated an increased risk of cardiovascular disease (CVD) in relation to high blood pressure in elderly patients aged below 70-75, whereas the risk seemed to decline with age in the older elderly. Early studies on the effect of treatment of mild to moderate hypertension in the elderly indicated (but did not convincingly show) a reduction of CVD. In the 1980s, both the EWPHE trial (European Working Party on High Blood Pressure in the Elderly) and the HEP study (The Randomised Trial of the Treatment of Hypertension in Elderly Patients in Primary Care) provided evidence of the benefit of treating high blood pressure in the elderly, at least up to the age of 70-74. These results have lately been confirmed by three major trials SHEP (Systolic Hypertension in the Elderly Program), STOP (Swedish Trial in Old Patients with Hypertension) and MRC (Medical Research Council), also including older patients (STOP) and those with isolated systolic hypertension (SHEP). This satisfactory effect was not impaired by a low tolerability of the drugs used (beta-blockers and diuretics). In conclusion, drug treatment with beta-blockers and diuretics in hypertensive men and women aged 70 and above confers highly significant and clinically relevant reductions in cardiovascular (especially stroke) morbidity and mortality. The clinical implication of this is that blood pressure lowering therapy should be considered in elderly hypertensives, at least up until they are 80. It should also be remembered that elderly hypertensives often have other diseases as well and that the drug treatment should be adjusted accordingly.