Hypertension in Aging Patients

Alexander G Logan

Disclosures

Expert Rev Cardiovasc Ther. 2011;9(1):113-120. 

In This Article

Abstract and Introduction

Abstract

Hypertension, especially isolated systolic hypertension, is commonly found in older (60–79 years of age) and elderly (≥80 years of age) people. Antihypertensive drug therapy should be considered in all aging hypertensive patients, as treatment greatly reduces cardiovascular events. Most classes of antihypertensive medications may be used as first-line treatment with the possible exception of α- and β-blockers. An initial blood pressure treatment goal is less than 140/90 mmHg in all older patients and less than 150/80 mmHg in the nonfrail elderly. The current paradigm of delaying therapeutic interventions until people are at moderate or high cardiovascular risk, a universal feature of hypertensive patients over 60 years of age, leads to vascular injury or disease that is only partially reversible with treatment. Future management will likely focus on intervening earlier to prevent accelerated vascular aging and irreversible arterial damage.

Introduction

Hypertension is a highly prevalent disorder in older people. In a recent population-based survey of adults aged 20–79 years in Canada, hypertension, defined as a blood pressure of 140/90 mmHg or more or being on antihypertensive medications, was present in 21.3% of the population overall and 51.6% among those 60–79 years of age.[1] Similar or even higher age-dependent prevalence rates have been reported worldwide.[2] Hypertension is a major risk factor for cardiovascular and renal disease, and numerous clinical trials including studies in older subjects have documented that effective treatment improves survival and confers cardiovascular benefits.[3,4]

The aim of this article is to summarize current knowledge about hypertension in aging individuals. In this article, older people aged 60–79 years are considered separately from the very old or elderly, defined as 80 years of age or more. The presence of comorbid conditions such as diabetes mellitus, chronic kidney disease or previous cardiovascular disease, which increases with age, may affect the epidemiology of hypertension and approach to treatment, especially in the elderly.

processing....