Updates on Treating Hypertension in Older People
Pp. 34-49 (16)
Danielle Wu and Kareeann Sok Fun Khow
Our population is ageing, and as older people (≥65 years of age) are affected
by hypertension, these individuals are at increased risk of organ damage or
cardiovascular disease (CVD). They pose many management dilemmas because most
hypertension trials had upper age limits with participant recruitment or did not present
age-specific results. Because evidence-based guidelines have limited information on
managing older patients with hypertension, recommendations are mostly based on
expert opinion. Drug treatment for elderly hypertensive patients are generally
recommended but with a greater degree of caution because of changes in drug
distribution and elimination, as well as the need to consider quality of life factors.
However, patients in most hypertension trials were aged <80 years. Pooling the limited
number of octogenarians from several trials, this group of treated patients showed a
reduction in both stroke and cardiovascular (CV) morbidity, but a trend toward higher
all-cause mortality compared to controls.
Therefore, the overall benefits of lowering the blood pressure in octogenarians remain
unclear despite epidemiological evidence that hypertension remains a major CV risk
factor in this age group. Resistant hypertension (i.e., blood pressure that remains above
target when patient adheres to lifestyle measures and maximum tolerated doses of
complementary antihypertensive agents which usually includes a diuretic) is more
frequent with advancing age. Older patients with higher baseline systolic blood
pressure characteristically have more severe or longer duration of hypertension,
resulting in more difficult blood pressure control because it is often associated with
autonomic dysfunction and organ damage.
Angiotensin-converting enzyme inhibitors, Antihypertensives, Betablockers,
Calcium channel antagonists, Cardiovascular diseases, Denervation of
renal artery, Diuretic, Elderly, Hypertension.
Department of Nephrology, Mackay Base Hospital, Mackay, Queensland, Australia.