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From Clinical Trials to Bedside: the Use of Antihypertensives in Aged Individuals. Part 1: Evaluation and Evidence of Treatment Benefit

  • Antihypertensive Agents: Mechanisms of Drug Action (ME Ernst, Section Editor)
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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 the individualization of treatment. In part 1, we discuss the evaluation of the aged hypertensive patient and review the clinical trial evidence for treatment benefit of hypertension in the elderly.

Recent Findings

Elderly patients with suspected hypertension need careful evaluation of their blood pressure, as errors in measurement technique, inaccurate devices, or overreliance on office blood pressure readings may lead to under- or over-treatment, thereby increasing risks of adverse medication effects and/or cardiovascular events. Epidemiologic evidence in older adults suggests a link between low blood pressure and increased mortality. However, key prospective hypertension trials such as HYVET and SPRINT, which were focused in mostly healthy, community-dwelling elderly cohorts, have unequivocally demonstrated benefits of lowering blood pressure in reducing cardiovascular events in the very elderly. Recent evidence also suggests benefit in reducing the risks of cognitive impairment.

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.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

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

    Eric J. MacLaughlin

  2. Department of Pharmacy Practice and Science, College of Pharmacy; and, 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

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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

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MacLaughlin, E.J., Ernst, M.E. From Clinical Trials to Bedside: the Use of Antihypertensives in Aged Individuals. Part 1: Evaluation and Evidence of Treatment Benefit. Curr Hypertens Rep 21, 82 (2019). https://doi.org/10.1007/s11906-019-0987-y

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