Management of hypertension in the very old: an intensive reduction of blood pressure should be achieved in most patients.
Fabio AngeliGianpaolo ReboldiPaolo VerdecchiaPublished in: Journal of human hypertension (2020)
There is large evidence that treatment of hypertension significantly reduces the risk of morbidity and mortality in the elderly. Although it is generally accepted that the benefit of antihypertensive treatment is largely explained by the reduction in systolic blood pressure, the optimal blood pressure target in elderly patients is still a topic of debate. Unfortunately, the clinical trials which demonstrated the benefit of antihypertensive treatment in old and very old patients with hypertension included relatively fit patients since frail patients were generally excluded. Available data suggest that when treating older adults, and especially frail older hypertensive adults, extra caution is appropriate in the setting of significant adverse events. Nonetheless, recent observations demonstrated a similar benefit from a more intensive compared with a less intensive blood pressure lowering in both fit and frail older adults. Of note, the rate of serious adverse events appears not dissimilar in the two treatment strategies, and not associated to frailty. Taken together, these findings support the concept that an intensive therapeutic strategy appears reasonable even in elderly hypertensive patients, particularly when the treatment is well tolerated.
Keyphrases
- blood pressure
- hypertensive patients
- end stage renal disease
- heart rate
- ejection fraction
- community dwelling
- newly diagnosed
- chronic kidney disease
- clinical trial
- physical activity
- prognostic factors
- blood glucose
- heart failure
- type diabetes
- adipose tissue
- patient reported
- left ventricular
- atrial fibrillation
- study protocol
- insulin resistance
- weight loss
- deep learning