European Geriatric Medicine

, Volume 9, Issue 2, pp 137–140 | Cite as

How to obtain more evidence for the management of hypertension in frail patients over 80 years old?

Special Article

Abstract

The current convention infers that an intensive treatment of hypertension is beneficial regardless of the patient’s health, age, frailty and living conditions. However in patients over the age of 80 with marked frailty and functional decline, several studies showed that low blood pressure levels under antihypertensive treatment may have deleterious effects. Presently, there are no specific guidelines for the most frail old hypertensive patients. We have recently coordinated an expert group composed from the European Geriatric Medicine Society (EUGMS) and the European Society of Hypertension (ESH) to revisit, several points of the 2013 ESH/ESC guidelines, concerning the management of hypertensive patients aged  ≥  80 with marked frailty and functional decline. Finally, we believe that it is necessary to obtain more evidence by including in the clinical trials not only selected robust older subjects, but also geriatric patients, i.e. individuals with multiple co-morbidities, cognitive impairment, functional decline, and loss of autonomy. These trials will be able to elucidate the potential benefits of therapeutic strategies according to the functional status and the degree of frailty of the older patients. In this respect, we coordinate a randomized controlled trial, called RETREAT-FRAIL, which evaluates the potential interest of the down-titration of antihypertensive treatment in subjects with too low BP levels.

Keywords

Hypertension Aging Older adults Mortality Randomized trials Overmedication 

Notes

Compliance with ethical statement

Conflict of interest

AB declares no conflict of interest

Ethical approval and informed consent

This study has received the Ethical approval and informed consent statements of the “comite de protection des personnes (CPP) Isle de France VII”.

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Copyright information

© European Geriatric Medicine Society 2018

Authors and Affiliations

  1. 1.Head of Department of Geriatric Medicine, CHRU de Nancy, and INSERM U1116Hôpital Brabois, Université de LorraineVandoeuvre-Lès-NancyFrance

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