Hypertension Management in Older and Frail Older Patients

Show full item record



Permalink

http://hdl.handle.net/10138/303985

Citation

Benetos , A , Petrovic , M & Strandberg , T 2019 , ' Hypertension Management in Older and Frail Older Patients ' , Circulation Research , vol. 124 , no. 7 , pp. 1045-1060 . https://doi.org/10.1161/CIRCRESAHA.118.313236

Title: Hypertension Management in Older and Frail Older Patients
Author: Benetos, Athanase; Petrovic, Mirko; Strandberg, Timo
Contributor: University of Helsinki, HUS Internal Medicine and Rehabilitation
Date: 2019-03-29
Language: eng
Number of pages: 16
Belongs to series: Circulation Research
ISSN: 0009-7330
URI: http://hdl.handle.net/10138/303985
Abstract: The prevalence of arterial hypertension, particularly systolic hypertension, is constantly rising worldwide. This is mainly the clinical expression of arterial stiffening as a result of the population's aging. Chronic elevation in blood pressure represents a major risk factor not only for cardiovascular morbidity and mortality but also for cognitive decline and loss of autonomy later in life. Clinical evidence obtained in community-dwelling older people with few comorbidities and preserved autonomy supports the beneficial effects of lowering blood pressure in older hypertensive subjects even after the age of 80 years. However, observational studies in frail older individuals treated for hypertension have shown higher morbidity and mortality rates compared with those with lower blood pressure levels. Clearly, in very old subjects, the therapeutic strategy of one size fits all cannot be applied because of the enormous functional heterogeneity in these individuals. Geriatric medicine proposes taking into account the function/ frailty/ autonomy status of older people. In the present review, we propose to adapt the antihypertensive treatment using an easy-to-apply visual numeric scale allowing the identification of 3 different patient profiles according to the functional status and autonomy for activities of daily living. For the preserved function profile, strategies should be those proposed for younger old adults. For the loss of function/ preserved activities of daily living' profile, a more detailed geriatric assessment is needed to define the benefit/ risk balance as well as requirements for the tailoring of the various therapeutic strategies. Lastly, for the loss of function and altered activities of daily living' profile, therapeutic strategies should be thoroughly reassessed, including deprescribing (when considered appropriate). In the near future, controlled trials are necessary for the most frail older subjects (ie, in those systematically excluded from previous clinical trials) to gain stronger evidence regarding the benefits of the various therapeutic strategies.
Subject: activities of daily living
aging
blood pressure
frailty
hypertension
HIGH BLOOD-PRESSURE
ALL-CAUSE MORTALITY
COMPREHENSIVE GERIATRIC ASSESSMENT
CONVERTING ENZYME-INHIBITORS
MODIFIABLE RISK-FACTORS
COLLEGE-OF-CARDIOLOGY
PULSE-WAVE VELOCITY
ORTHOSTATIC HYPOTENSION
ARTERIAL STIFFNESS
CARDIOVASCULAR-DISEASE
3121 General medicine, internal medicine and other clinical medicine
Rights:


Files in this item

Total number of downloads: Loading...

Files Size Format View
CIRCRESAHA.118.313236.pdf 934.3Kb PDF View/Open

This item appears in the following Collection(s)

Show full item record