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Polifarmacia en el Envejecimiento del Paciente: Manejo de la Hipertensión en Octogenarios
Athanase Benetos1, Patrick Rossignol2, Antonio Cherubini3
1Department of Geriatrics and FHU-CARTAGE, CHU de Nancy, Université de Lorraine, Nancy, France.
JAMA
|July 15, 2015
Resumen
El tratamiento de la hipertensión beneficia a los octogenarios saludables e independientes. Sin embargo, la evidencia es insuficiente para pacientes frágiles y ancianos con múltiples medicamentos, que requieren atención individualizada.
Área de la Ciencia:
- Gerontología Gerontología.
- Medicina Cardiovascular La medicina cardiovascular es una especialidad de la salud.
- Farmacología clínica Farmacología clínica.
Sus antecedentes:
- El manejo de la hipertensión es crucial para la mayoría de los pacientes.
- Los beneficios del tratamiento de la hipertensión en individuos muy viejos y frágiles que toman múltiples medicamentos son menos claros.
Objetivo del estudio:
- Establecer recomendaciones para la evaluación y el tratamiento de la hipertensión en pacientes de 80 años o más.
Principales métodos:
- Buscado en MEDLINE, PubMed Central y en la base de datos Cochrane de revisiones sistemáticas (inicio en abril de 2015).
- Se incluyeron ensayos controlados aleatorios (ECA) sobre el uso de antihipertensivos en octogenarios, centrados en análisis post hoc de la hipertensión en el ensayo de personas muy mayores (HYVET).
Principales resultados:
- El ensayo HYVET (N=3845) mostró una reducción de la mortalidad total y los puntos finales cardiovasculares, pero no alcanzó una significación estadística para la prevención del accidente cerebrovascular.
- Los análisis post hoc indicaron beneficios para la hipertensión de bata blanca, la cognición y la prevención de posibles fracturas.
- Los pacientes en HYVET vivían en la comunidad y eran menos discapacitados que la población octogenaria en general.
Conclusiones:
- Los pacientes hipertensivos saludables y funcionalmente independientes mayores de 80 años deben seguir las pautas para los mayores de 65 años.
- El tratamiento para los octogenarios frágiles y polimedicados carece de pruebas suficientes y requiere enfoques individualizados.
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