Treatment of hypertension in older patients in 2024: What’s new?
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Mar 26, 2024
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Abstract
Older individuals represent the greatest proportion of patients with arterial hypertension. For several decades, the management of old (>60-65 years) and very old (>80 years) patients with hypertension has been relatively conservative because of the paucity of scientific evidence of clinical benefits and the fear of doing more harm than good. Yet, in recent years, major changes in the therapeutic approach of older hypertensive patients have occurred leading to lower thresholds and treatment targets in most recent guidelines such as those of the European Society of Hypertension. These latter now emphasize the need to assess frailty properly in all older patients to propose the most accurate drug treatments, to start antihypertensive therapy prudently with a monotherapy in very old hypertensive patients (>80 years) and to reassess periodically the overall medications to avoid overtreatments. In this review, the recent changes in the management of older patients are discussed comparing several recent recommendations from national and international guidelines.
Keywords:
prevalence, thresholds, target, blood pressure, deprescription, frailty
Article Details
How to Cite
BURNIER, Michel.
Treatment of hypertension in older patients in 2024: What’s new?.
Medical Research Archives, [S.l.], v. 12, n. 3, mar. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5168>. Date accessed: 30 apr. 2024.
doi: https://doi.org/10.18103/mra.v12i3.5168.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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19. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, Bulpitt CJ, de Leeuw PW, Dollery CT, Fletcher AE, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350:757-764. doi: 10.1016/s0140-6736(97)05381-6
20. Lonn EM, Bosch J, López-Jaramillo P, Zhu J, Liu L, Pais P, Diaz R, Xavier D, Sliwa K, Dans A, et al. Blood-Pressure Lowering in Intermediate -Risk Persons without Cardiovascular Disease. N Engl J Med. 2016;374:2009-2020.
doi: 10.1056/NEJMoa1600175
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doi: 10.1056/NEJMoa2111437
23. Briasoulis A, Agarwal V, Tousoulis D, Stefanadis C. Effects of antihypertensive treatment in patients over 65 years of age: a meta-analysis of randomised controlled studies. Heart. 2014;100:317-323.
doi: 10.1136/heartjnl-2013-304111
24. Brunström M, Carlberg B, Kjeldsen SE. Effect of antihypertensive treatment in isolated systolic hypertension (ISH) - systematic review and meta-analysis of randomised controlled trials. Blood Press. 2023;32:2226757. doi: 10.1080/08037051.2023.2226757
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doi: 10.1097/hjh.0000000000003476
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doi: 10.1161/HYPERTENSIONAHA.120.14683
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34. Sheppard JP, Benetos A, Bogaerts J, Gnjidic D, McManus RJ. Strategies for Identifying Patients for Deprescribing of Blood Pressure Medications in Routine Practice: An Evidence Review. Curr Hypertens Rep. 2024. doi: 10.1007/s11906-024-01293-5
2. Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, Muiesan ML, Tsioufis K, Agabiti-Rosei E, Algharably EAE, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41:1874-2071.
doi: 10.1097/hjh.0000000000003480
3. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36:1953-2041. doi: 10.1097/hjh.0000000000001940
4. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/ AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:1269-1324. doi: 10.1161/hyp.0000000000000066
5. Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, Ramirez A, Schlaich M, Stergiou GS, Tomaszewski M, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020;75:1334-1357. doi: 10.1161/hypertensionaha.120.15026
6. Kim HL, Lee EM, Ahn SY, Kim KI, Kim HC, Kim JH, Lee HY, Lee JH, Park JM, Cho EJ, et al. The 2022 focused update of the 2018 Korean Hypertension Society Guidelines for the management of hypertension. Clin Hypertens. 2023;29:11. doi: 10.1186/s40885-023-00234-9
7. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, Horio T, Hoshide S, Ikeda S, Ishimitsu T, et al. The Japanese Society of Hypertension Guidelines for the Management of Hypertension (JSH 2019). Hypertens Res. 2019;42:1235-1481. doi: 10.1038/s41440-019-0284-9
8. Rabi DM, McBrien KA, Sapir-Pichhadze R, Nakhla M, Ahmed SB, Dumanski SM, Butalia S, Leung AA, Harris KC, Cloutier L, et al. Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J Cardiol. 2020;36:596-624.
doi: 10.1016/j.cjca.2020.02.086
9. Pitkala KH, Strandberg TE. Clinical trials in older people. Age Ageing. 2022;51. doi: 10.1093/ageing/afab282
10. Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation. 2023;147:e93-e621. doi: 10.1161/cir.0000000000001123
11. Lacruz ME, Kluttig A, Hartwig S, Loer M, Tiller D, Greiser KH, Werdan K, Haerting J. Prevalence and Incidence of Hypertension in the General Adult Population: Results of the CARLA-Cohort Study. Medicine (Baltimore). 2015;94:e952. doi: 10.1097/MD.0000000000000952
12. Vasan RS, Beiser A, Seshadri S, Larson MG, Kannel WB, D'Agostino RB, Levy D. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA. 2002;287:1003-1010. doi: 10.1001/jama.287.8.1003
13. Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF. Arterial Stiffness and Cardiovascular Risk in Hypertension. Circ Res. 2021;128:864-886. doi: 10.1161/CIRCRESAHA.121.318061
14. Benetos A, Petrovic M, Strandberg T. Hypertension Management in Older and Frail Older Patients. Circ Res. 2019;124:1045-1060. doi: 10.1161/circresaha.118.313236
15. Bromfield SG, Bowling CB, Tanner RM, Peralta CA, Odden MC, Oparil S, Muntner P. Trends in hypertension prevalence, awareness, treatment, and control among US adults 80 years and older, 1988-2010. J Clin Hypertens (Greenwich). 2014;16:270-276. doi: 10.1111/jch.12281
16. Streit S, Poortvliet RKE, Gussekloo J. Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old. Data from the Leiden 85-plus Study. Age Ageing. 2018;47:545-550. doi: 10.1093/ageing/afy072
17. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, Stoyanovsky V, Antikainen RL, Nikitin Y, Anderson C, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358: 1887-1898. doi: 10.1056/NEJMoa0801369
18. Perry HM, Davis BR, Price TR, Applegate WB, Fields WS, Guralnik JM, Kuller L, Pressel S, Stamler J, Probstfield JL. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke: the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 2000;284: 465-471. doi: 10.1001/jama.284.4.465
19. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, Bulpitt CJ, de Leeuw PW, Dollery CT, Fletcher AE, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350:757-764. doi: 10.1016/s0140-6736(97)05381-6
20. Lonn EM, Bosch J, López-Jaramillo P, Zhu J, Liu L, Pais P, Diaz R, Xavier D, Sliwa K, Dans A, et al. Blood-Pressure Lowering in Intermediate -Risk Persons without Cardiovascular Disease. N Engl J Med. 2016;374:2009-2020.
doi: 10.1056/NEJMoa1600175
21. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, Fine LJ, Haley WE, Hawfield AT, Ix JH, et al. Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial. JAMA. 2016;315:2673-2682. doi: 10.1001/jama.2016.7050
22. Zhang W, Zhang S, Deng Y, Wu S, Ren J, Sun G, Yang J, Jiang Y, Xu X, Wang TD, et al. Trial of Intensive Blood-Pressure Control in Older Patients with Hypertension. N Engl J Med. 2021;385:1268-1279.
doi: 10.1056/NEJMoa2111437
23. Briasoulis A, Agarwal V, Tousoulis D, Stefanadis C. Effects of antihypertensive treatment in patients over 65 years of age: a meta-analysis of randomised controlled studies. Heart. 2014;100:317-323.
doi: 10.1136/heartjnl-2013-304111
24. Brunström M, Carlberg B, Kjeldsen SE. Effect of antihypertensive treatment in isolated systolic hypertension (ISH) - systematic review and meta-analysis of randomised controlled trials. Blood Press. 2023;32:2226757. doi: 10.1080/08037051.2023.2226757
25. Thomopoulos C. Target blood pressure in isolated systolic hypertension: a meta-analysis of randomized outcome trials. J Hypertens. 2023;41:2113-2114.
doi: 10.1097/hjh.0000000000003476
26. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 13 - benefits and adverse events in older and younger patients with hypertension: overview, meta-analyses and meta-regression analyses of randomized trials. J Hypertens. 2018;36: 1622-1636. doi: 10.1097/hjh.0000000000001787
27. Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA, Clinical Guidelines Committee of the American College of P, the Commission on Health of the P, Science of the American Academy of Family P, Fitterman N, et al. Pharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166:430-437. doi: 10.7326/M16-1785
28. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752-762. doi: 10.1016/s0140-6736(12)62167-9
29. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489-495. doi: 10.1503/cmaj.050051
30. Pulok MH, Theou O, van der Valk AM, Rockwood K. The role of illness acuity on the association between frailty and mortality in emergency department patients referred to internal medicine. Age Ageing. 2020;49: 1071-1079. doi: 10.1093/ageing/afaa089
31. Burnier M, Polychronopoulou E, Wuerzner G. Hypertension and Drug Adherence in the Elderly. Front Cardiovasc Med. 2020;7:49. doi: 10.3389/fcvm.2020.00049
32. Rea F, Cantarutti A, Merlino L, Ungar A, Corrao G, Mancia G. Antihypertensive Treatment in Elderly Frail Patients: Evidence From a Large Italian Database. Hypertension. 2020;76:442-449.
doi: 10.1161/HYPERTENSIONAHA.120.14683
33. Sheppard JP, Benetos A, McManus RJ. Antihypertensive Deprescribing in Older Adults: a Practical Guide. Curr Hypertens Rep. 2022; 24:571-580. doi: 10.1007/s11906-022-01215-3
34. Sheppard JP, Benetos A, Bogaerts J, Gnjidic D, McManus RJ. Strategies for Identifying Patients for Deprescribing of Blood Pressure Medications in Routine Practice: An Evidence Review. Curr Hypertens Rep. 2024. doi: 10.1007/s11906-024-01293-5