Managing the elderly patient with hypertension: current strategies, challenges, and considerations

ABSTRACT

Introduction: Hypertension is the leading modifiable risk factor for cardiovascular events and mortality in the world.

Areas covered: An extensive literature review of articles and clinical trials on PUBMED on the topic of hypertension in the elderly from 1976 through January 2020 was conducted. This review article discusses clinical trials on treatment of hypertension in the elderly, the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines, the 2018 European Society of Cardiology/European Society of Hypertension guidelines, and the treatment of hypertension and of resistant hypertension in the elderly.

Expert opinion: The 2017 ACC/AHA hypertension guidelines recommend treatment of noninstitutionalized ambulatory community-dwelling adults aged 65 years and older with an average systolic blood pressure of 130 mm Hg or higher with lifestyle measures plus antihypertensive drug to lower the blood pressure to less than 130/80 mm Hg. For elderly adults with hypertension and a high burden of comorbidities and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit is reasonable for decisions about the intensity of SBP lowering and the choice of antihypertensive drugs to use for treatment.

KEYWORDS:

• Hypertension
• systolic blood pressure
• diastolic blood pressure
• elderly

Article highlights

• Reduce the blood pressure to less than 130/80 mm Hg in elderly persons with hypertension.

• The initial antihypertensive drug for elderly persons with primary hypertension is a thiazide diuretic (preferably chlorthalidone) or a calcium channel blocker.

• If three antihypertensive drugs are needed, they should be a thiazide diuretic plus a calcium channel blocker plus an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.

• If a fourth antihypertensive drug is needed to treat resistant hypertension, add a mineralocorticoid antagonist.

• The choice of antihypertensive drug therapy would be modified depending on the comorbidities present.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.