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From Clinical Trials to Bedside: the Use of Antihypertensives in Aged Individuals. Part 2: Approach to Treatment

  • Antihypertensive Agents: Mechanisms of Drug Action (ME Ernst, Section Editor)
  • Published:
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Abstract

Purpose of Review

Use of antihypertensives in older adults can be complicated by the potential for undesired effects on comorbidities, adverse effects of the drugs, and overall medication burden. The purpose of this two-part review is to discuss contemporary issues encountered in the management of hypertension in aged individuals, with a particular focus on considerations for the individualization of treatment. In Part 2, we discuss the individualized approach to treating hypertension in the elderly.

Recent Findings

Achieving lower blood pressure goals in older adults has the potential to increase risks for complications such as hypotension and acute renal insufficiency, especially in those less healthy. Because elderly exhibit many different phenotypes, a one-size-fits-all approach to treatment goals and choice of antihypertensives is problematic. Many areas of uncertainty remain, including what the optimal goal blood pressure should be in frail or institutionalized elderly, whether there is an upper age limit for treatment initiation where benefits and risks overlap, and when de-escalation of antihypertensives should be considered.

Summary

Hypertension is a major modifiable risk factor, and the benefits of treatment in lowering cardiovascular events are realized for most individuals, even at advanced ages. Areas of uncertainty in the management of hypertension in this group mandate a cautious, individualized approach to treatment which relies on careful assessment of biologic or phenotypic age, rather than chronologic age alone.

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Authors and Affiliations

  1. Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, IA, USA

    Michael E. Ernst

  2. Department of Family Medicine,Carver College of Medicine, The University of Iowa, 01291-A PFP, 200 Hawkins Dr, Iowa City, IA, 52242, USA

    Michael E. Ernst

  3. Department of Pharmacy Practice, Jerry H. Hodge School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA

    Eric J. MacLaughlin

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Correspondence to Michael E. Ernst.

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This article is part of the Topical Collection on Antihypertensive Agents: Mechanisms of Drug Action

For additional background information on this topic, the reader is referred to the accompanying prior manuscript, “From Clinical Trials to Bedside: the Use of Antihypertensives in Aged Individuals. Part 1: Evaluation and Evidence of Treatment Benefit.”

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Ernst, M.E., MacLaughlin, E.J. From Clinical Trials to Bedside: the Use of Antihypertensives in Aged Individuals. Part 2: Approach to Treatment. Curr Hypertens Rep 21, 83 (2019). https://doi.org/10.1007/s11906-019-0988-x

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  • DOI: https://doi.org/10.1007/s11906-019-0988-x

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