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Hypertension in the Very Old: Special Features, Therapeutic Approaches, and Problems

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Special Issues in Hypertension

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Abstract

Systolic hypertension is a common condition in the elderly and is considered a major determinant not only of cardiovascular morbidity and mortality, but also cognitive decline, frailty and loss of autonomy. We have now evidence that in community living hypertensive subjects over 80 years old, decreasing blood pressure with pharmacological treatment is able to reduce the rate of cardiovascular events and total mortality. By contrast the efficacy of this treatment in preventing dementia is more controversial. A systolic BP of 150 mmHg is an acceptable cut-off value both for the diagnosis of hypertension and as a target for treatment in most patients >80 years old. To avoid over-treating, it is important to confirm the diagnosis with blood pressure monitoring at home. Treatment should be initiated and followed up in a shared decision making process, taking the patients’ preferences into account. The risk of drug-induced orthostatic hypotension should always be taken into account but should rarely be a reason not to treat. Avoiding “going too low” is important not only at the initiation of therapy, but also during follow-up. Prospectively, other than blood pressure values could better evaluate the age-related arterial alterations especially in the very elderly frail subjects. In this respect, assessment of arterial stiffness could provide significant new information in order to estimate the risk and evaluate the potential benefits of treatment in the very elderly.

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Author information

Authors and Affiliations

  1. CHU de Nancy, Nancy les Vandoeuvre, 54511, France

    Athanase Benetos

  2. Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland

    Ulrich M. Vischer

  3. Department of Geriatrics, University Hospital of Nancy, Vandoeuvre les Nancy, 54511, France

    Ghassan Watfa

Authors
  1. Athanase Benetos
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  2. Ulrich M. Vischer
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  3. Ghassan Watfa
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Corresponding author

Correspondence to Athanase Benetos .

Editor information

Editors and Affiliations

  1. , Internal Medicine, American University of Beirut Medical Ce, Riad El Solh, Beirut, 1107-2020, Lebanon

    Adel E. Berbari

  2. Clinica Medica, Ospedale S. Gerardo, Università di Milano-Bicocca, V .Donizetti 106, Milano, Monza, 20133, Italy

    Giuseppe Mancia

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Benetos, A., Vischer, U.M., Watfa, G. (2012). Hypertension in the Very Old: Special Features, Therapeutic Approaches, and Problems. In: Berbari, A., Mancia, G. (eds) Special Issues in Hypertension. Springer, Milano. https://doi.org/10.1007/978-88-470-2601-8_5

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  • DOI: https://doi.org/10.1007/978-88-470-2601-8_5

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