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Current Management of Hypertension in Older Adults

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Abstract

Hypertension is a major global health issue and it accounts for a big proportion of disability and mortality worldwide even in adults aged 65 years and above. Moreover, advanced age per se is an independent risk factor for adverse cardiovascular events and there is abundant scientific evidence supporting the beneficial effects of blood pressure lowering, within certain limits, in this subset of hypertensive patients. The aim of this review article is to summarize the available evidence regarding the appropriate management of hypertension in this specific subgroup, in an era of a constantly increasing aging population.

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References

  1. Baffour-Awuah B, Dieberg G, Pearson MJ, Smart NA. Blood pressure control in older adults with hypertension: a systematic review with meta-analysis and meta-regression. Int J Cardiol Hypertens. 2020;6: 100040.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Forouzanfar MH, Liu P, Roth GA, Ng M, Biryukov S, Marczak L, et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990–2015. JAMA. 2017;317:165–82.

    Article  PubMed  Google Scholar 

  3. Oliveros E, Patel H, Kyung S, Fugar S, Goldberg A, Madan N, et al. Hypertension in older adults: assessment, management, and challenges. Clin Cardiol. 2020;43:99–107.

    Article  PubMed  Google Scholar 

  4. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  PubMed  Google Scholar 

  5. Burnier M, Polychronopoulou E, Wuerzner G. Hypertension and drug adherence in the elderly. Front Cardiovasc Med. 2020;7:49.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zieleniewicz P, Zdrojewski T. Current guidelines and controversies in the diagnosis and therapy of hypertension in the elderly and very elderly: a review of international recommendations. Arterial Hypertension. 2020;24:1–9.

    Article  CAS  Google Scholar 

  7. Harrison DG, Coffman TM, Wilcox CS. Pathophysiology of hypertension: the mosaic theory and beyond. Circ Res. 2021;128:847–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Higashi Y, Kihara Y, Noma K. Endothelial dysfunction and hypertension in aging. Hypertens Res. 2012;35:1039–47.

    Article  CAS  PubMed  Google Scholar 

  9. Benetos A, Petrovic M, Strandberg T. Hypertension management in older and frail older patients. Circ Res. 2019;124:1045–60.

    Article  CAS  PubMed  Google Scholar 

  10. Durham AL, Speer MY, Scatena M, Giachelli CM, Shanahan CM. Role of smooth muscle cells in vascular calcification: implications in atherosclerosis and arterial stiffness. Cardiovasc Res. 2018;114:590–600.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sasaki N, Yamamoto H, Ozono R, Fujiwara S, Kihara Y. Association of N-terminal pro B-type natriuretic peptide with blood pressure and pulse pressure in elderly people: a cross-sectional population study. Circ J. 2018;82:2049–54.

    Article  CAS  PubMed  Google Scholar 

  12. Low PA, Tomalia VA. Orthostatic hypotension: mechanisms, causes, management. J Clin Neurol. 2015;11:220–6.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Musso CG, Jauregui JR. Renin-angiotensin-aldosterone system and the aging kidney. Expert Rev Endocrinol Metab. 2014;9:543–6.

    Article  CAS  PubMed  Google Scholar 

  14. Sierra C. Hypertension and the risk of dementia. Front Cardiovasc Med. 2020;7:5.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

    Article  PubMed  Google Scholar 

  16. Rapsomaniki E, Timmis A, George J, Pujades-Rodriguez M, Shah AD, Denaxas S, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014;383:1899–911.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wilson PW. Established risk factors and coronary artery disease: the Framingham Study. Am J Hypertens. 1994;7:7S-12S.

    Article  CAS  PubMed  Google Scholar 

  18. Franklin SS, Larson MG, Khan SA, Wong ND, Leip EP, Kannel WB, et al. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation. 2001;103:1245–9.

    Article  CAS  PubMed  Google Scholar 

  19. Papademetriou V. From hypertension to heart failure. J Clin Hypertens (Greenwich). 2004;6:14–7.

    Article  PubMed  Google Scholar 

  20. Thrift AG, McNeil JJ, Forbes A, Donnan GA. Risk factors for cerebral hemorrhage in the era of well-controlled hypertension. Melbourne Risk Factor Study (MERFS) Group. Stroke. 1996;27:2020–5.

    Article  CAS  PubMed  Google Scholar 

  21. Haddadin F, Munoz Estrella A, Herzog E. Hypertensive emergency presenting with acute spontaneous subdural hematoma. J Cardiol Cases. 2019;19:25–8.

    Article  PubMed  Google Scholar 

  22. Coresh J, Wei GL, McQuillan G, Brancati FL, Levey AS, Jones C, et al. Prevalence of high blood pressure and elevated serum creatinine level in the United States: findings from the third National Health and Nutrition Examination Survey (1988–1994). Arch Intern Med. 2001;161:1207–16.

    Article  CAS  PubMed  Google Scholar 

  23. Bhargava M, Ikram MK, Wong TY. How does hypertension affect your eyes? J Hum Hypertens. 2012;26:71–83.

    Article  CAS  PubMed  Google Scholar 

  24. American College of Cardiology. Older adults and hypertension: beyond the 2017 guideline for prevention, detection, evaluation, and management of high blood pressure in adults. https://www.acc.org/latest-in-cardiology/articles/2020/02/26/06/24/http%3a%2f%2fwww.acc.org%2flatest-in-cardiology%2farticles%2f2020%2f02%2f26%2f06%2f24%2folder-adults-and-hypertension. Accessed 14 Jan 2023.

  25. Flack JM, Adekola B. Blood pressure and the new ACC/AHA hypertension guidelines. Trends Cardiovasc Med. 2020;30:160–4.

    Article  PubMed  Google Scholar 

  26. Mediavilla García JD, Jaén Águila F, Fernández Torres C, Gil Extremera B, Jiménez AJ. Ambulatory blood pressure monitoring in the elderly. Int J Hypertens. 2012;2012: 548286.

    Article  PubMed  Google Scholar 

  27. Parati GMG. The role of ambulatory blood pressure monitoring in elderly hypertensive patients. Blood Press. 2000;9:12–6.

    Article  PubMed  Google Scholar 

  28. Camafort M, Chung W-J, Shin J-H. Role of ambulatory blood pressure monitoring in elderly hypertensive patients. Clin Hypertens. 2022;28:22.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Oza R, Garcellano M. Nonpharmacologic management of hypertension: what works? Am Fam Physician. 2015;91:772–6.

    PubMed  Google Scholar 

  30. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Hypertension. 2018;71:1269–324.

    Article  CAS  PubMed  Google Scholar 

  31. Verma N, Rastogi S, Chia Y-C, Siddique S, Turana Y, Cheng H-M, et al. Non-pharmacological management of hypertension. J Clin Hypertens (Greenwich). 2021;23:1275–83.

    Article  PubMed  Google Scholar 

  32. De Pergola G, D’Alessandro A. Influence of Mediterranean diet on blood pressure. Nutrients. 2018;10:1700.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Shea MK, Nicklas BJ, Houston DK, Miller ME, Davis CC, Kitzman DW, et al. The effect of intentional weight loss on all-cause mortality in older adults: results of a randomized controlled weight-loss trial. Am J Clin Nutr. 2011;94:839–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63:2985–3023.

    Article  PubMed  Google Scholar 

  35. Barone Gibbs B, Hivert M-F, Jerome GJ, Kraus WE, Rosenkranz SK, Schorr EN, et al. Physical activity as a critical component of first-line treatment for elevated blood pressure or cholesterol: who, what, and how? A scientific statement from the American Heart Association. Hypertension. 2021;78:e26-37.

    Article  CAS  PubMed  Google Scholar 

  36. Wahid A, Manek N, Nichols M, Kelly P, Foster C, Webster P, et al. Quantifying the association between physical activity and cardiovascular disease and diabetes: a systematic review and meta-analysis. J Am Heart Assoc. 2016;5: e002495.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Dickerson LM, Gibson MV. Management of hypertension in older persons. Am Fam Physician. 2005;71:469–76.

    PubMed  Google Scholar 

  38. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288:2981–97.

    Article  Google Scholar 

  39. Dahlöf B, Devereux RB, Kjeldsen SE, Julius S, Beevers G, de Faire U, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet. 2002;359:995–1003.

    Article  PubMed  Google Scholar 

  40. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet. 2005;366:895–906.

    Article  PubMed  Google Scholar 

  41. Mancia G, Grassi G, Zanchetti A. New-onset diabetes and antihypertensive drugs. J Hypertens. 2006;24:3–10.

    Article  CAS  PubMed  Google Scholar 

  42. Hansson L. Future goals for the treatment of hypertension in the elderly with reference to STOP-Hypertension, SHEP, and the MRC trial in older adults. Am J Hypertens. 1993;6:40S-43S.

    Article  CAS  PubMed  Google Scholar 

  43. Fagard RH, Staessen JA. Treatment of isolated systolic hypertension in the elderly: the Syst-Eur trial. Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Clin Exp Hypertens. 1999;21:491–7.

    Article  CAS  PubMed  Google Scholar 

  44. Wang JG, Staessen JA, Gong L, Liu L. Chinese trial on isolated systolic hypertension in the elderly. Systolic Hypertension in China (Syst-China) Collaborative Group. Arch Intern Med. 2000;160:211–20.

    Article  CAS  PubMed  Google Scholar 

  45. Bulpitt CJ, Fletcher AE, Amery A, Coope J, Evans JG, Lightowlers S, et al. The hypertension in the very elderly trial (HYVET). J Hum Hypertens. 1994;8:631–2.

    CAS  PubMed  Google Scholar 

  46. Cushman WC, Whelton PK, Fine LJ, Wright JT, Reboussin DM, Johnson KC, et al. SPRINT trial results: latest news in hypertension management. Hypertension. 2016;67:263–5.

    Article  CAS  PubMed  Google Scholar 

  47. Jovanovich A, Ginsberg C, You Z, Katz R, Ambrosius WT, Berlowitz D, et al. FGF23, frailty, and falls in SPRINT. J Am Geriatr Soc. 2021;69:467–73.

    Article  PubMed  Google Scholar 

  48. Takami Y, Yamamoto K, Arima H, Sakima A. Target blood pressure level for the treatment of elderly hypertensive patients: a systematic review and meta-analysis of randomized trials. Hypertens Res. 2019;42:660–8.

    Article  PubMed  Google Scholar 

  49. Musini VM, Tejani AM, Bassett K, Puil L, Wright JM. Pharmacotherapy for hypertension in adults 60 years or older. Cochrane Database Syst Rev. 2019;6: CD000028.

    PubMed  Google Scholar 

  50. Lee J-H, Kim K-I, Cho M-C. Current status and therapeutic considerations of hypertension in the elderly. Korean J Intern Med. 2019;34:687–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Cheng L, Fu Q, Zhou L, Fan Y, Liu F, Fan Y, et al. Effect of SGLT-2 inhibitor, empagliflozin, on blood pressure reduction in Chinese elderly hypertension patients with type 2 diabetes and its possible mechanisms. Sci Rep. 2022;12:3525.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Gupta R, Maitz T, Egeler D, Mehta A, Nyaeme M, Hajra A, et al. SGLT2 inhibitors in hypertension: role beyond diabetes and heart failure. Trends Cardiovasc Med. 2022. https://doi.org/10.1016/j.tcm.2022.05.005.

    Article  PubMed  Google Scholar 

  53. Aronow WS. Managing hypertension in the elderly: what’s new? Am J Prev Cardiol. 2020;1: 100001.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Ferdinand KC, Balavoine F, Besse B, Black HR, Desbrandes S, Dittrich HC, et al. Efficacy and safety of firibastat, a first-in-class brain aminopeptidase A inhibitor, in hypertensive overweight patients of multiple ethnic origins. Circulation. 2019;140:138–46.

    Article  CAS  PubMed  Google Scholar 

  55. Gupta R, Alcantara R, Popli T, Tariq U, Sood A, Mahajan S, et al. Firibastat: a novel brain aminopeptidase inhibitor: a new era of antihypertensive therapy. Curr Probl Cardiol. 2022;47: 100859.

    Article  PubMed  Google Scholar 

  56. Johnson AG, Simons LA, Simons J, Friedlander Y, McCallum J. Non-steroidal anti-inflammatory drugs and hypertension in the elderly: a community-based cross-sectional study. Br J Clin Pharmacol. 1993;35:455–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  57. Aronow WS. Drug-induced causes of secondary hypertension. Ann Transl Med. 2017;5:349.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Gupta R, Behnoush AH, Egeler D, Aronow WS. Effect of acetaminophen on blood pressure: a systematic review and meta-analysis of randomized controlled trials. Eur J Prev Cardiol. 2022;29:e326–30.

    Article  PubMed  Google Scholar 

  59. MacIntyre IM, Turtle EJ, Farrah TE, Graham C, Dear JW, Webb DJ, et al. Regular acetaminophen use and blood pressure in people with hypertension: the PATH-BP Trial. Circulation. 2022;145:416–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Hermida RC, Crespo JJ, Domínguez-Sardiña M, Otero A, Moyá A, Ríos MT, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J. 2020;41:4565–76.

    Article  CAS  PubMed  Google Scholar 

  61. Hermida RC, Ayala DE, Mojón A, Fernández JR. Influence of circadian time of hypertension treatment on cardiovascular risk: results of the MAPEC study. Chronobiol Int. 2010;27:1629–51.

    Article  PubMed  Google Scholar 

  62. Gupta R, Malik AH, Popli T, Ranchal P, Yandrapalli S, Aronow WS. Impact of bedtime dosing of antihypertensives compared to morning therapy: a meta-analysis of randomised controlled trials. Eur J Prev Cardiol. 2021;28:e5-8.

    Article  PubMed  Google Scholar 

  63. Mackenzie IS, Rogers A, Poulter NR, Williams B, Brown MJ, Webb DJ, et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet. 2022;400:1417–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Medical School, European University Cyprus, 76 Siggrou avenue, 11742, Athens, Greece

    Dimitrios G. Chatzis

  2. Department of Internal Medicine, KAT General Hospital of Athens, Athens, Greece

    Kalliopi Magounaki

  3. Department of Emergency Medicine, Medical School, University of Thessaly, Larissa, Greece

    Ioannis Pantazopoulos

  4. Department of Thoracic and Cardiovascular Surgery, West Germany Heart Center, University Clinic Essen, Essen, Germany

    Eleftherios T. Beltsios

  5. Department of Cardiology, School of Medicine, Ηippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Vasiliki Katsi

  6. 1st Cardiology Clinic, School of Medicine, Ηippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Konstantinos P. Tsioufis

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Correspondence to Dimitrios G. Chatzis.

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Dimitrios G. Chatzis, Kalliopi Magounaki, Ioannis Pantazopoulos, Eleftherios T Beltsios, Vasiliki Katsi, and Konstantinos P. Tsioufis have no conflicts of interest that are directly relevant to the content of this article.

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DGC, KM, IP, ETB, and VK contributed equally to manuscript writing. DGC, KM, IP, ETB, VK, and KPT contributed equally to gathering the relevant data. KPT and DC contributed equally to the final revision and polishing of this paper.

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Chatzis, D.G., Magounaki, K., Pantazopoulos, I. et al. Current Management of Hypertension in Older Adults. Drugs Aging 40, 407–416 (2023). https://doi.org/10.1007/s40266-023-01013-9

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