Pharmacological Management of Hypertension in the Elderly - Certitudes and Controversies
Karolina Piotrowicz, Ewa Kucharska, Anna Skalska, Aleksander Kwater, Seetha Bhagavatula and Jerzy Gasowski
Affiliation: Department of Internal Medicine and Geriatrics, Jagiellonian University, ul. Sniadeckich 10, 31-537 Krakow, Poland.
Keywords: Hypertension, elderly, randomised clinical trial, hypertension guidelines, therapeutic goal, antihypertensive medications.
This paper summarizes the evidence supporting the pharmacological treatment of hypertension in the elderly as well as some
the remaining controversies. The world is becoming progressively older and with that, the prevalence of hypertension is increasing. A peculiar
form of hypertension, most prevalent among the elderly, is isolated systolic hypertension (ISH). Hypertension in the elderly, especially
when systolic blood pressure (SBP) exceeds 160 mm Hg should be treated. Lowering the SBP to less than 150 mm Hg confers substantial
cardiovascular protection. This has been demonstrated in both older and newer drugs for ISH and systolo-diastolic hypertension
and is beneficial in both younger individuals (60-79 years) and uncomplicated elderly (80+ years) individuals suffering from hypertension.
However, a number of issues remain controversial. Firstly, the 140 mm Hg cut-off for SBP cannot be applied to all age groups. It is
conceivable that lowering the SBP below 140mm Hg in some patients, particularly in the elderly may not be beneficial. Hence, the generalizations
made in clinical trials should be approached with caution. Additionally some drugs, such as beta-blockers, thiazide diuretics
may be associated with significantly less benefit in the elderly patients. More research is needed, especially in the areas where we lack
data: the first stage of uncomplicated ISH or hypertension in the elderly with associated co-morbidities.
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