Case Report on Hypertension in Elderly Patients

2010

We compared the efficacy and adverse effects of antihypertensive drug regimens in 690 men past age 60 with diastolic blood pressure 90-114 mm Hg and systolic blood pressure less than 240 mm Hg. They received either a low (25-50 mg) or high (50-100 mg) dose of hydrochlorothiazide daily. Of 644 patients who completed the hydrochlorothiazide titration, 375 (58.2%) were responders (diastolic blood pressure <90 and <5 mm Hg below baseline) and 92.8% of these completed a 6-month maintenance period. Blood pressure was reduced from 157.6/98.5 mm Hg by 18.3/9.5 mm Hg with low dose hydrochlorothiazide and by 20.4/9.6 mm Hg with high dose hydrochlorothiazide; more patients achieved goal blood pressure with the high dose. Whites and blacks responded equally. Serum potassium less than 3.5 mmol/1 occurred in 104 of 321 (32.3%) of the high dose versus 62 of 333 (18.6%) of the low dose hydrochlorothiazide patients. The 269 nonresponders to hydrochlorothiazide were randomly assigned in a double-blind study to receive hydralazine, methyldopa, metoprolol, or reserpine in addition to hydrochlorothiazide; 79.2% responded to the addition of the second drug and 87.3% of these completed a 6-month maintenance phase. Overall, there were no significant efficacy differences among the step 2 regimens. We conclude that the lower dose of hydrochlorothiazide was nearly as effective as the higher dose, and the addition of a second drug was effective and generally well tolerated in elderly patients. (Hypertension 1990;15:348-360) strate improvement in previously demonstrated behavioral deficits in young men and women after long-term antihypertensive therapy.

Cardiovascular Drugs and Therapy, 1988

2011

Hypertension therapy in elderly patients still constitutes a considerable challenge. Its importance is also emphasized by the fact that, nowadays, many inter national organizations focus on the problem of an aging society (in 2030, life expectancy at birth in the European Union 27 is expected to rise to 85.3 years for women and 80.0 years for men). They discuss not only the optimal therapy in elderly patients, the problem of compliance and polypragmasy, but also the quality of life as well as the social, economic, and psycho logical challenges associated with this patient group. However, neither the available trials nor the European Society of Hypertension guidelines (2009) finally answered all important questions on hypertension management in elderly people. Thus, the first official recommendations on hypertension therapy in this patient group were much expected. The American College of Cardiology Foundation/ American Heart Association 2011 Expert Consensus Document on Hypertension in the Elderly was published on April 25, 2011. The present article summarizes the most important issues discussed in this document.

2020

Hypertension is an important risk factor for cardiovascular morbidity and mortality, particularly in the elderly. It is defined as persistently elevated arterial blood pressure(BP). Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease (CHD) deaths in India. Both SBP and DBP increase with age. In elderly persons there are specific underlying mechanisms of HTN, including mechanical hemodynamic changes, arterial stiffness, neurohormonal and autonomic dysregulation, and the aging kidney. The goals and strategies for treating hypertension in the elderly population are different from, and more challenging than, in younger patients. Lifestyle modification is effective in this population, but it is difficult to maintain There is often a debate about which antihypertensive drug class should be used first in elderly patients with hypertension. Combination of low dose diuretic (chlorthalidone) and a beta blocker(Atenolol) appears to be suitabl...

Reviews, 1996

Medicina Moderna - Modern Medicine, 2018

Introduction: Monitoring of antihypertensive therapy is a challenge for any patient, but especially for the elderly. Management of high blood pressure in the elderly raised many questions about lowering blood pressure and the risk of falls. Methods: A cross-sectional, observational study of 150 patients; mean-age 74.68±7.49 years with antihypertensive therapy. Daily blood pressure and hemodynamic modulators (volemia, inotropism, chronotropism) were measured using thoracic electrical impedance (TEB-System HOTMAN ®). The evaluated haemodynamic profi le was correlated with each administered antihypertensive drug/class. Results: 79.5% of patients were therapeutically controlled; 93.1% had at least one modifi ed hemodynamic modulator (p <0.0001). Distribution of antihypertensive drugs: Indapamidum (85.7%), Carvedilolum (42.9%), Perindoprilum (36.7%), Candesartanum (16.3%). The correlation between hemodynamic and antihypertensive modulators: 72.7% had hypervolemia; only 29.7% were treated with diuretics, with statistically signifi cant results [x2=2.79;p=0.09]; patients treated with ACEI/ARBs had hypoinotropism (52.3%)/hyperinotropism (40.9%). 54.5% of patients with beta-blockers had statistically signifi cant results for hypocronotropy [x2=11.35; p=0.001]. Conclusions: Hemodynamic profi le helps identify the causes of uncontrolled hypertension with different classes of antihypertensive drugs. The effect of beta blockers on chronotropism is depending on age and type (selective/non-selective). The effect of thiazide diuretics, associated with a high risk of falls in the elderly, shows the presence of hypervolemia in a small rate, which implies individualized treatment at the elderly, depending on comorbidities and drug interactions.

Polskie Archiwum Medycyny Wewnętrznej, 2013

The prevalence of hypertension is rising with age, and current evidence shows that the majority of elderly patients benefit from proper antihypertensive therapy. To support physicians in everyday care of elderly patients with hypertension, new guidelines were issued in Poland at the end of 2012. In 2013, the guidelines started to be implemented into practice. The aim of this article is to present an overview of the major recommendations included in these 2013 guidelines. Physicians should be aware of the key issues specific for the care of the elderly hypertensive population. Lowering blood pressure below 150/90 mmHg should be considered as the goal of therapy in hypertensive patients older than 80 years. Slight overweight (body mass index, 27-28 kg/m2) may be beneficial for patients older than 75 years and especially for octogenarians because it may prevent protein and calorie deficiency. Thiazide-like diuretics followed by angiotensin-converting-enzyme inhibitors, if needed, shoul...

Journal of the renin-angiotensin-aldosterone system : JRAAS, 2002

The number of people over the age of 65 years continues to increase. In most societies blood pressure (BP) increases with age and elevated levels of BP are common in the elderly.The elderly are also a high-risk group for cardiovascular (CV) disease, which is the leading cause of death in most developed countries. Several intervention trials have confirmed lower CV disease risk in hypertensive patients aged into their early eighties when treated with a variety of antihypertensive drugs. Whilst there is some limited evidence to suggest that β-blockers may not be as effective as thiazide diuretics in reducing coronary heart disease (CHD) or total mortality in the elderly, the combination of the two agents and thiazides alone appear to be as effective as newer agents, such as angiotensin-converting enzyme inhibitors (ACE-I) and calcium antagonists. There was no evidence from these trials that BP reduction in the elderly was associated with any deleterious effects. Whilst the benefits of treating the elderly hypertensive are well established, some issues remain to be clarified, particularly in relation to treating the very elderly and the potential benefits beyond BP control that may be afforded by newer antihypertensive agents.

Current Pharmaceutical Design, 2014

This paper summarizes the evidence supporting the pharmacological treatment of hypertension in the elderly as well as some the remaining controversies. The world is becoming progressively older and with that, the prevalence of hypertension is increasing. A peculiar form of hypertension, most prevalent among the elderly, is isolated systolic hypertension (ISH). Hypertension in the elderly, especially when systolic blood pressure (SBP) exceeds 160 mm Hg should be treated. Lowering the SBP to less than 150 mm Hg confers substantial cardiovascular protection. This has been demonstrated in both older and newer drugs for ISH and systolo-diastolic hypertension and is beneficial in both younger individuals (60-79 years) and uncomplicated elderly (80+ years) individuals suffering from hypertension. However, a number of issues remain controversial. Firstly, the 140 mm Hg cut-off for SBP cannot be applied to all age groups. It is conceivable that lowering the SBP below 140mm Hg in some patients, particularly in the elderly may not be beneficial. Hence, the generalizations made in clinical trials should be approached with caution. Additionally some drugs, such as beta-blockers, thiazide diuretics may be associated with significantly less benefit in the elderly patients. More research is needed, especially in the areas where we lack data: the first stage of uncomplicated ISH or hypertension in the elderly with associated co-morbidities.

New England Journal of Medicine, 2008