Treatment of hypertension in the elderly in 2017/2018 - what’s new?

ABSTRACT

Introduction: Hypertension is highly prevalent in the elderly and represents a major risk factor for cardiovascular complications such as coronary heart disease, stroke, and cognitive dysfunction.

Areas covered: The recently published AHA/ACC and ESC/ESH guidelines for the management of hypertension in adult populations modified their approach towards hypertension in the elderly, particularly in those older than 85 years. The new concepts presented in these guidelines are discussed. They recommend a less conservative threshold and lower blood pressures targets; an emphasis on considering the biological rather than chronological age for patients >85 years, and the use of single-pill combinations to simplify treatment algorithms and increase long-term drug adherence.

Expert opinion: Considering the high prevalence of hypertension in the elderly and the negative impact of untreated hypertension, early detection of hypertension in patients over 60 years old is crucial. The screening of hypertension should be reinforced in patient populations using out-of-office BP measurements. The author supports the latest ESC/ESH guidelines, which define a threshold at >140 mmHg for patients aged 65 to 79 years and >160 mmHg for those >85 years and propose a target BP of 130–140 mmHg, while considering patient frailty and the tolerability of the treatment.

KEYWORDS:

• Target blood pressure
• thresholds
• frailty
• octogenarians
• single pill
• adherence

Article highlights

• The recent ESC/ESH European guidelines and the AHA/ACC American guidelines for the treatment of hypertension in adults have modified their approach to the treatment of elderly patients with hypertension.

• The recommended target BP for all elderly patients is now <130/80 mmHg according to the US and <140/90 mmHg according to European guidelines.

• However, it is important to take into account the frailty of the patients and the tolerance to the treatment.

• Single-pill combinations should be used to treat elderly patients to simplify their drug regimen and increase their long-term adherence.

• A drug monotherapy can still be considered to initiate treatment in a very old patient.

This box summarizes key points contained in the article.

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 manuscript was not funded.