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L’hypertension artérielle chez le sujet âgé : prise en charge thérapeutique en intégrant les dernières recommandations européennes et nord-américaines

Arterial hypertension in elderly patients: a reassessment in the light of recent European and North American recommendations

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Les cahiers de l'année gérontologique

Résumé

L’hypertension artérielle (HTA) est un facteur de risque cardiovasculaire dont l’incidence augmente avec l’âge. Il demeure un facteur de risque cardiovasculaire chez le sujet âgé, au moins jusqu’à 85 ans, principalement associé à un risque cérébrovasculaire. Depuis les résultats de l’étude HYVET, il est clairement établi que traiter l’HTA chez l’octogénaire apporte un bénéfice favorable sur la morbimortalité. Jusqu’à 80 ans, les objectifs de pression artérielle [PA] sont identiques à ceux des sujets d’âge moyen (≤ 140/90 mmHg). Après 80 ans, les objectifs sont plutôt de 140–150/80–90 mmHg. Cinq antihypertenseurs peuvent être utilisés en première intention: les diurétiques thiazidiques, les inhibiteurs de l’enzyme de conversion (IEC), les antagonistes du récepteur de l’angiotensine 2 (ARA-2), les anticalciques dihydropyridiniques et les bêtabloquants. L’aliskiren n’a à ce jour pas montré de bénéfice sur la morbimortalité. Il est recommandé de ne pas utiliser plus de trois molécules d’antihypertenseurs chez le sujet âgé. L’utilisation des IEC, des ARA-2 ou des diurétiques thiazidiques impose une surveillance régulière de l’ionogramme sanguin et de la fonction rénale. La prise en charge d’un sujet âgé hypertendu doit comporter une évaluation gériatrique standardisée comportant notamment une évaluation des fonctions cognitives.

Abstract

Arterial hypertension is a risk factor for cardiovascular disease, the incidence of which increases with age. It remains a cardiovascular risk factor with elderly patients, at least up until the age of 85, and is mainly associated with cerebrovascular risk. Since the results of the HYVET test, it has been clearly established that treating arterial hypertension among patients in their eighties provides encouraging benefits on morbidity and mortality. Up to the age of 80, the objectives in terms of blood pressure are identical to those for middle-aged people (≤ 140/90 mmHg). After the age of 80, the objectives are more generally around 140–150 /80–90 mmHg. Five antihypertensives can initially be used: thiazide diuretics, conversion enzyme inhibitors (CEI), angiotensin 2 receptor blockers (ARA-2), dihydropyridine calcium blockers and beta blockers. To date, aliskiren has not shown any benefits in terms of morbidity or mortality. It is recommended to use no more than three antihypertensive drugs with elderly patients. The use of CEIs, ARA-2s or thiazide diuretics requires regular monitoring of the blood ionogram and of kidney function. Treating elderly patients with high blood pressure should include a standardized geriatric assessment, which should include a cognitive function assessment.

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Authors and Affiliations

  1. Pôle de gériatrie, hôpitaux universitaires de Strasbourg, Strasbourg, France

    T. Vogel & G. Kaltenbach

  2. EA-3072, institut de physiologie, faculté de médecine, université de Strasbourg, Strasbourg, France

    T. Vogel & B. Geny

  3. Explorations fonctionnelles, hôpitaux universitaires de Strasbourg, Strasbourg, France

    B. Geny

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  1. T. Vogel
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  2. G. Kaltenbach
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Vogel, T., Kaltenbach, G. & Geny, B. L’hypertension artérielle chez le sujet âgé : prise en charge thérapeutique en intégrant les dernières recommandations européennes et nord-américaines. cah. année gerontol. 5, 234–244 (2013). https://doi.org/10.1007/s12612-013-0356-4

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