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Hypertension Treatment in Frail Older Adults: A Systematic Review and Appraisal of Guidelines

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Abstract

Background

Managing hypertension in frail older patients is challenging. Several institutions and organizations have published up-to-date hypertension guidelines suggesting frailty screening among older hypertensive patients, with new recommendations for blood pressure-lowering treatment among the frail population. However, the quality of current hypertension guidelines and the consistency of antihypertension treatment recommendations for frail older patients and their supporting evidence remain unknown.

Objective

In this review, we aimed to systematically collect guidelines with antihypertension treatment recommendations for frail older patients, examine and compare these recommendations, and critically assess reporting and methodology quality of these guidelines.

Methods

A literature search was conducted on two databases and three major websites of guideline development organizations. The AGREE instrument and RIGHT checklist were used to evaluate the methodology and reporting quality of the guidelines, respectively. The consistency of recommendations within the guidelines were compared using descriptive analysis.

Results

We identified 13 hypertension guidelines. The overall methodology quality scores (range 23.35–79.07%) and reporting rates (range 10/35–29/35) varied among these guidelines. Four guidelines provided an explicit definition of frailty. Considering treatment tolerability or increased likelihood of adverse effects while using pharmacotherapy in frail older patients was mentioned in all guidelines. Ten guidelines recommended adjusting blood pressure targets or specific pharmacotherapy programs. Four guidelines recommended using clinical judgment when prescribing. However, the specific recommendations lacked clarity and unity without sufficient evidence.

Conclusions

There were considerable variations in methodology and reporting quality across the 13 included hypertension guidelines. Furthermore, the depth and breadth of antihypertension treatment recommendations for frail older patients were varied and inconsistent. Further trials exploring optimal treatment are urgently required to promote the development of specific guidelines for managing frail older hypertensive patients.

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Acknowledgments

We thank all members of our study team for their whole-hearted cooperation.

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Author notes

  1. Kaiyan Hu and Gang Zhou are co-first authors.

Authors and Affiliations

  1. Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China

    Kaiyan Hu & Bin Ma

  2. The First Clinical Medicine College, Lanzhou University, Lanzhou, 730000, China

    Gang Zhou

  3. Department of Cardiology, Gansu Provincial Hospital, Lanzhou, 730000, China

    Gang Zhou

  4. Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China

    Mengyao Jiang

  5. Department of Neurology, China-Japan Friendship Hospital, Beijing, 100000, China

    Xiaohong Wei

  6. Department of Critical Care Medicine, SunYat-sen University Cancer Center, Guangzhou, 510000, China

    Jing Yu

  7. Department of Cardiology, Ningxia Medical University General Hospital, Yinchuan, 750000, China

    Li liu

  8. Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, 730000, China

    Zhe Wang

  9. Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, 730000, China

    Liyuan Feng

  10. Evidence-based Nursing Center, School of Nursing, Lanzhou University, Lanzhou, 730000, China

    Mei Wu

  11. Department of Cardiology, Gansu Gem Flower Hospital, Lanzhou, 730000, China

    Tao Li

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  1. Kaiyan Hu
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Conflict of interest

K.H., G.Z., M.J., X.W., J.Y., L.L., Z.W., L.F., M.W., T.L., and B.M. declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Funding

This work was supported by the National Natural Science Foundation of China (Number: 81873184). The funders had no role in the study design, interpretation of the data, or preparation of the manuscript.

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All data generated or analyzed during this study are included in this published article and its supplementary information files.

Authors' contributions

K.H., B.M., and G.Z. conceived and designed the research. K.H., G.Z., and L.L. designed the data collection. J.Y., Z.W., L.F., M.W., X.W., T.L., and K.H. performed the data collection. J.Y. performed the statistical analysis. K.H., G.Z., T.L., L.L., M.J., X.W., and B.M. interpreted the data. K.H. wrote the first draft of the manuscript. All authors revised the manuscript for important intellectual content and read and approved the final manuscript.

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Hu, K., Zhou, G., Jiang, M. et al. Hypertension Treatment in Frail Older Adults: A Systematic Review and Appraisal of Guidelines. Drugs Aging 40, 881–893 (2023). https://doi.org/10.1007/s40266-023-01053-1

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