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New concepts in hypertension: focus on the elderly
1Department of Preventive Medicine, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill 60612, USA.
Insights
Hypertension is common in older adults, increasing cardiovascular and cerebrovascular risks. Treating high blood pressure in the elderly, including isolated systolic hypertension, is safe, effective, and cost-effective.
Area of Science:
- Gerontology
- Cardiology
- Public Health
Background:
- The global population is aging, leading to a higher prevalence of hypertension in elderly individuals.
- Elderly patients face greater cardiovascular and cerebrovascular risks from hypertension compared to younger populations.
- Systolic hypertension, often due to age-related arterial stiffening, constitutes over 50% of hypertension cases in the elderly.
Purpose of the Study:
- To evaluate the efficacy and safety of antihypertensive therapy in the elderly population.
- To assess the impact of blood pressure reduction on cardiovascular and cerebrovascular outcomes in older adults.
- To determine the cost-effectiveness of hypertension management in the elderly.
Main Methods:
- Analysis of large-scale, controlled, randomized trials on antihypertensive therapy in elderly individuals.
- Review of evidence demonstrating the benefits of blood pressure reduction on morbidity and mortality rates.
- Examination of studies focusing on isolated systolic hypertension in older patients.
Main Results:
- Antihypertensive therapy in the elderly safely and effectively reduces cerebrovascular and cardiovascular morbidity and mortality.
- Treatment benefits extend to decreasing the incidence of stroke, myocardial infarction, and left ventricular failure, even in isolated systolic hypertension.
- Antihypertensive treatment is more cost-effective in the elderly due to higher risks associated with untreated hypertension.
Conclusions:
- Elevated blood pressure management is crucial for reducing adverse cardiovascular and cerebrovascular events in the aging population.
- Antihypertensive therapy offers significant benefits for elderly patients, including those with isolated systolic hypertension.
- Further research is needed to determine optimal antihypertensive agents and treatment thresholds for specific elderly subgroups, such as those with stage I isolated systolic hypertension.
Abstract:
The proportion of elderly individuals in the population is on the rise, and hypertension is extremely common in this age group. In addition, the cardiovascular and cerebrovascular risks associated with elevated blood pressure levels are greater in the elderly than in their younger counterparts. Systolic hypertension accounts for >50% of hypertensive cases in the elderly, probably as a result of arterial stiffening and loss of arterial compliance that occurs with aging. Large-scale, controlled, randomized trials have provided conclusive evidence that reduction of elevated blood pressure levels in the elderly safely and effectively decreases cerebrovascular and cardiovascular morbidity and mortality rates. The benefit of antihypertensive therapy in decreasing the incidence of stroke, myocardial infarction, and left ventricular failure has also been demonstrated to apply to patients with isolated systolic hypertension. Because the risks associated with untreated hypertension are greater in older than in younger patients, and the relative gains associated with treatment in the two groups are comparable, antihypertensive treatment is actually more cost-effective in the elderly population. Issues that remain to be resolved in future studies include which antihypertensive agents are most appropriate for use in older patients and whether it is appropriate to treat so-called stage I isolated systolic hypertension.