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Hypertension Management at Older Age: An Update

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Abstract

Hypertension is a risk factor for cardiovascular morbidity and mortality with increasing prevalence with age, whose treatment is associated with benefits over fatal and non-fatal cardiovascular events even later in life. However, there are persistent concerns on the short- and long-term weighted benefits of treating hypertension in the very old, particularly in those with specific clinical features. In fact, a broad range of clinical scenarios can be observed at older ages, spanning from the healthy to the frailest patient, and hypertension clinical trials have traditionally excluded the latter, thus preventing the unconditioned application to these patients of the same recommendations as in younger ages. Persistent issues regarding high blood pressure management in the very old adult are mainly related to treatment threshold and targets, which have been differently addressed by American and European guidelines. Herein, we will examine the challenges related to high blood pressure treatment in healthy and frail older and very old adults. We will discuss the evidence behind current recommendations. Finally, we will recapitulate the recommended treatment options for high blood pressure in these patients in the light of the most recent guidelines.

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Fig. 1

(modified from the 2018 ESC/ESH Guidelines for the management of arterial hypertension [8])

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  1. Department of Life, Health and Environmental Sciences, University of L’Aquila, San Salvatore Hospital, Delta 6 building, 67100, L’Aquila, Italy

    Rita Del Pinto & Claudio Ferri

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CF conceived the manuscript and provided critical guidance, RDP wrote the first draft, RDP and CF edited the manuscript. Both authors read and approved the final version of the manuscript.

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Del Pinto, R., Ferri, C. Hypertension Management at Older Age: An Update. High Blood Press Cardiovasc Prev 26, 27–36 (2019). https://doi.org/10.1007/s40292-018-0290-z

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