Skip to main content
Top
Published in: Current Hypertension Reports 5/2010

01-10-2010

Hypertension in the Elderly: What Is the Goal Blood Pressure Target and How Can This Be Attained?

Authors: Bo Carlberg, Peter M. Nilsson

Published in: Current Hypertension Reports | Issue 5/2010

Login to get access

Abstract

For the aging populations of Europe, many emerging health problems in addition to myocardial infarction and stroke are associated with hypertension. Recently, the role of hypertension in the risk of vascular cognitive impairment and dementia has been highlighted, and there are studies to show that control of hypertension may slow this process. Furthermore, as many elderly individuals will also develop type 2 diabetes or impaired renal function, the risk of hypertension in these patients is more pronounced. New guidelines have tried to provide evidence-based treatment algorithms in which control of hypertension is just one aspect of general risk factor control, with the aim of decreasing the total risk.
Literature
1.
go back to reference • Driver JA, Djoussé L, Logroscino G, et al.: Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study. BMJ 2008, 337:a2467. This is an important epidemiologic observational study of morbidity and mortality in the oldest old. CrossRefPubMed • Driver JA, Djoussé L, Logroscino G, et al.: Incidence of cardiovascular disease and cancer in advanced age: prospective cohort study. BMJ 2008, 337:a2467. This is an important epidemiologic observational study of morbidity and mortality in the oldest old. CrossRefPubMed
2.
go back to reference Molander L, Lövheim H, Norman T, et al.: Lower systolic blood pressure is associated with greater mortality in people aged 85 and older. J Am Geriatr Soc 2008, 56:1853–1859.CrossRefPubMed Molander L, Lövheim H, Norman T, et al.: Lower systolic blood pressure is associated with greater mortality in people aged 85 and older. J Am Geriatr Soc 2008, 56:1853–1859.CrossRefPubMed
3.
go back to reference Vasan RS, Beiser A, Seshadri S, et al.: Residual lifetime risk for developing hypertension in middle-aged women and men. The Framingham Heart Study. JAMA 2002, 287:1003–1010.CrossRefPubMed Vasan RS, Beiser A, Seshadri S, et al.: Residual lifetime risk for developing hypertension in middle-aged women and men. The Framingham Heart Study. JAMA 2002, 287:1003–1010.CrossRefPubMed
4.
go back to reference Coope J, Warrender TS: Randomised trial of treatment of hypertension in elderly patients in primary care. BMJ 1986, 293:1145–1150.CrossRefPubMed Coope J, Warrender TS: Randomised trial of treatment of hypertension in elderly patients in primary care. BMJ 1986, 293:1145–1150.CrossRefPubMed
5.
go back to reference Amery A, Brixko R, Clement D: Efficacy of antihypertensive drug treatment according to age, sex, blood pressure, and previous cardiovascular disease in patients over the age of 60. Lancet 1985, 328:589–592.CrossRef Amery A, Brixko R, Clement D: Efficacy of antihypertensive drug treatment according to age, sex, blood pressure, and previous cardiovascular disease in patients over the age of 60. Lancet 1985, 328:589–592.CrossRef
6.
go back to reference Prevention of stroke by antihypertensive drug treatment in older patients with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program. SHEP Cooperative Research Group. JAMA 1991, 265:3255–3264. Prevention of stroke by antihypertensive drug treatment in older patients with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program. SHEP Cooperative Research Group. JAMA 1991, 265:3255–3264.
7.
go back to reference Staessen JA, Fagard R, Thijs L, et al.: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997, 350:757–764.CrossRefPubMed Staessen JA, Fagard R, Thijs L, et al.: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997, 350:757–764.CrossRefPubMed
8.
go back to reference Dahlof B, Lindholm LH, Hansson L, et al.: Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991, 338:1281–1285.CrossRefPubMed Dahlof B, Lindholm LH, Hansson L, et al.: Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991, 338:1281–1285.CrossRefPubMed
9.
go back to reference Medical Research Council Trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ 1992, 304:405–412. Medical Research Council Trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ 1992, 304:405–412.
10.
go back to reference Musini VM, Tejani AM, Bassett K, Wright JM: Pharmacotherapy for hypertension in the elderly. Cochrane Database Syst Rev 2009, (4):CD000028. Musini VM, Tejani AM, Bassett K, Wright JM: Pharmacotherapy for hypertension in the elderly. Cochrane Database Syst Rev 2009, (4):CD000028.
11.
go back to reference PROGRESS Collaborative Group: Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischemic attack. Lancet 2001, 358:1033–1041.CrossRef PROGRESS Collaborative Group: Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischemic attack. Lancet 2001, 358:1033–1041.CrossRef
12.
go back to reference Rodgers A, Chapman N, Woodward M, et al.: Perindopril-based blood pressure lowering in individuals with cerebrovascular disease: consistency of benefits by age, sex and region. J Hypertens 2004, 22:653–659.CrossRefPubMed Rodgers A, Chapman N, Woodward M, et al.: Perindopril-based blood pressure lowering in individuals with cerebrovascular disease: consistency of benefits by age, sex and region. J Hypertens 2004, 22:653–659.CrossRefPubMed
13.
go back to reference Gueyffier F, Bulpitt C, Boissel JP, et al.: Antihypertensive drugs in very old people: a subgroup meta-analysis of randomized controlled trials. Lancet 1999, 353:793–796.CrossRefPubMed Gueyffier F, Bulpitt C, Boissel JP, et al.: Antihypertensive drugs in very old people: a subgroup meta-analysis of randomized controlled trials. Lancet 1999, 353:793–796.CrossRefPubMed
14.
go back to reference •• Beckett NS, Peters R, Fletcher AE, et al; HYVET Study Group: Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008, 358:1887–1898. This is the first and only randomized controlled trial investigating the effect of antihypertensive treatment on morbidity and mortality in patients more than 80 years of age.CrossRefPubMed •• Beckett NS, Peters R, Fletcher AE, et al; HYVET Study Group: Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008, 358:1887–1898. This is the first and only randomized controlled trial investigating the effect of antihypertensive treatment on morbidity and mortality in patients more than 80 years of age.CrossRefPubMed
15.
go back to reference • Peters R, Beckett N, Forette F, et al.: Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind placebo controlled trial. Lancet Neurol 2008, 7:683–689. This study showed that antihypertensive therapy prescribed to old patients does not increase the risk for dementia.CrossRefPubMed • Peters R, Beckett N, Forette F, et al.: Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind placebo controlled trial. Lancet Neurol 2008, 7:683–689. This study showed that antihypertensive therapy prescribed to old patients does not increase the risk for dementia.CrossRefPubMed
16.
go back to reference Messerli FH, Grossman E, Goldbourt U: Are β-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review. JAMA 1998, 279:1903–1907.CrossRefPubMed Messerli FH, Grossman E, Goldbourt U: Are β-blockers efficacious as first-line therapy for hypertension in the elderly? A systematic review. JAMA 1998, 279:1903–1907.CrossRefPubMed
17.
go back to reference Khan N, McAlister FA: Re-examining the efficacy of β-blockers for the treatment of hypertension: a meta-analysis. CMAJ 2006, 174:1737–1742.PubMed Khan N, McAlister FA: Re-examining the efficacy of β-blockers for the treatment of hypertension: a meta-analysis. CMAJ 2006, 174:1737–1742.PubMed
18.
go back to reference Mancia G, de Backer G, Dominiczak A, et al.: 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007, 25:1105–1187.CrossRefPubMed Mancia G, de Backer G, Dominiczak A, et al.: 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007, 25:1105–1187.CrossRefPubMed
19.
go back to reference Mancia G, Laurent S, Agabiti-Rosei E, et al.: Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009 Oct 15 (Epub ahead of print). Mancia G, Laurent S, Agabiti-Rosei E, et al.: Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009 Oct 15 (Epub ahead of print).
20.
go back to reference • Butt TF, Branch RL, Beesley L, Martin U: Managing hypertension in the very elderly: Effect of adverse drug reactions (ADRs) on achieving targets. J Hum Hypertens. 2010, 24:514–518. This article describes obstacles (such as problems related to adverse drug effects and interactions) in applying hypertension guidelines in old patients. • Butt TF, Branch RL, Beesley L, Martin U: Managing hypertension in the very elderly: Effect of adverse drug reactions (ADRs) on achieving targets. J Hum Hypertens. 2010, 24:514–518. This article describes obstacles (such as problems related to adverse drug effects and interactions) in applying hypertension guidelines in old patients.
Metadata
Title
Hypertension in the Elderly: What Is the Goal Blood Pressure Target and How Can This Be Attained?
Authors
Bo Carlberg
Peter M. Nilsson
Publication date
01-10-2010
Publisher
Current Science Inc.
Published in
Current Hypertension Reports / Issue 5/2010
Print ISSN: 1522-6417
Electronic ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-010-0138-y

Other articles of this Issue 5/2010

Current Hypertension Reports 5/2010 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.