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Managing Hypertension in Patients Aged 75 Years and Older

  • Blood Pressure Monitoring and Management (J Cockcroft, Section Editor)
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Abstract

On the basis of the available data, we would diagnose a normal blood pressure in elderly persons including those 75 years of age and older if the blood pressure was below 120/80 mmHg. We would diagnose hypertension in elderly persons including those aged 75 years and older if the systolic blood pressure was 130 mmHg and higher or if the diastolic blood pressure was 80 mmHg and higher. We would treat these elderly patients with hypertension to a blood pressure goal of less than 130/80 mmHg if the blood pressure was obtained by automated blood pressure monitoring in a quiet room. We would consider treating high-risk persons aged 75 years and older to a blood pressure goal of less than 120/80 mmHg if they were carefully monitored for serious adverse events. If the blood pressure is more than 20/10 mmHg above the goal blood pressure, we would initiate antihypertensive drug therapy with two antihypertensive drugs. The initial drug of choice for the treatment of hypertension in adults aged 75 years and older should be based on co-morbidities, co-incidental indications, tolerability, and cost.

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References

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  1. WHO. A global brief on hypertension. 2013; www.who.int/cardiovascular_diseases/publications/global_brief_hypertension/en/, <http://www.who.int/cardiovascular_diseases/

  2. Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G, Cowan MJ, et al. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. Lancet. 2017;389:37–55.

    Article  Google Scholar 

  3. Bavishi C, Goel S, Messerli FH. Isolated systolic hypertension: an update after SPRINT. Am J Med. 2016;129:1251–8.

    Article  PubMed  Google Scholar 

  4. Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Developed in collaborationwith the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Coll Cardiol. 2011;57:2037–114.

    Article  PubMed  Google Scholar 

  5. Staessen J, Fagard R, Amery A. Isolated systolic hypertension in the elderly: implications of Systolic Hypertension in the Elderly Program (SHEP) for clinical practice and for the ongoing trials. J Hum Hypertens. 1991;5:469–74.

    CAS  PubMed  Google Scholar 

  6. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–98.

    Article  CAS  PubMed  Google Scholar 

  7. •• Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16. Compared to a systolic blood pressure goal below 140 mm Hg, a systolic blood pressure goal below 120 mm Hg reduced in 9,361 persons at 3.26 years the primary composite outcome ofmyocardial infarction, other acute coronary syndrome, stroke, heart failure, or death from cardiovascular causes by25%(p<0.0-01), all-cause mortality by 27%(p = 0.003), heart failure by 38% (p = 0.002), death from cardiovascular causes by 43%(p = 0.005)), and the primary composite outcome or death by 22% (p <0.001).

    Article  CAS  PubMed  Google Scholar 

  8. •• Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years. A randomized clinical trial. JAMA. 2016;315:2673–82. At 3.14-year median follow-up of 2,636 persons aged 75 years and older, mean age 79.9 years, compared with a systolic blood pressure goal of less than 140 mm Hg, a systolic blood pressure goal of less than 120 mm Hg reduced the primary endpoint of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or cardiovascular death by 34% (p = 0.001), all-cause mortality by 33%(p =0.009), heart failure by 38% (p = 0.003), and the primary outcome or death by32% (p<0.001).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control clinical perspective. Circulation. 2016;134:441–50.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortalty: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–13.

    Article  PubMed  Google Scholar 

  11. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:3255–64.

    Article  Google Scholar 

  12. Perry HM Jr, Davis BR, Price TR, Applegate WB, Fields WS, Guralnik JM, et al. Effect of treating isolated systolic hypertension on the risk of developing various types and subtypes of stroke. The Systolic Hypertension in the Elderly Program (SHEP). JAMA. 2000;284:465–71.

    Article  PubMed  Google Scholar 

  13. Kostis JB, Davis BR, Cutler J, Grimm RH Jr, Berge KG, Cohen JD, et al. Prevention of heart failure by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA. 1997;278:212–6.

    Article  CAS  PubMed  Google Scholar 

  14. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH, et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet. 1997;350:757–64.

    Article  CAS  PubMed  Google Scholar 

  15. Liu L, Wang J-G, Gong L, Liu G, Staessen JA. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China(Syst-China) Collaborative Group. J Hypertens. 1998;16:1823–9.

    Article  CAS  PubMed  Google Scholar 

  16. Staessen JA, Gasowski J, Wang JG, Thijs L, Den Hond E, Boissel JP, et al. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet. 2000;355:865–72.

    Article  CAS  PubMed  Google Scholar 

  17. RobinsonK.Trends in health and aging trends in health status and health care use among older women. 2007 ;https://www.cdc.gov/nchs/data/ahcd/agingtrends/07olderwomen.pdf

  18. Blok CGH, de Ridder MAJ, Verhamme KMC, Moorman PW. Hypertension in older patients, a retrospective cohort study. BMC Geriatr. 2016;16:142.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Biskupiak JE, Kim J, Phatak H, Wu D. Prevalence of high-risk cardiovascular conditions and the status of hypertension management among hypertensive adults 65 years and older in the United States: analysis of a primary care electronic medical records database. J Clin Hypertens. 2010;12:935–44.

    Article  Google Scholar 

  20. Aronow WS. Managing hypertension in the elderly: what is different, what is the same? Curr Hypertens Rep. 2017;19:67.

    Article  PubMed  Google Scholar 

  21. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34:2159–219.

    Article  PubMed  Google Scholar 

  22. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults. Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311:507–20.

    Article  CAS  PubMed  Google Scholar 

  23. Wright JT Jr, Fine LJ, Lackland DT, Ogedegbe G, Dennison-Himmelfarb C. Evidence supporting a systolic blood pressure goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med. 2014;160:499–503.

    Article  PubMed  Google Scholar 

  24. Krakoff LR, Gillespie RL, Ferdinand KC, Fergus IV, Akinboboye O, Williams KA, et al. 2014 hypertension recommendations from the Eighth Joint National Committee Members raise concerns for elderly black and female populations. J Am Coll Cardiol. 2014;64:394–402.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Hackam DG, Quinn RR, Ravani P, Rabi DM, Dasgupta K, Daskalopoulou SS, et al. The 2013 Canadian Hypertension Education Program recommendations for blood pressure measurement, diagnosis, assessment of risk, prevention, and treatment of hypertension. Can J Cardiol. 2013;29:528–42.

    Article  PubMed  Google Scholar 

  26. •• WeberMA, Schiffrin EL WhiteWB, MannS, LindholmLH, KenersonJG, et al. Clinical practice guidelines for the management of hypertension in the community. A statement by the American Society of Hypertension and the International Society of Hypertension. 2014;16:14–26. These guidelines recommend that the blood pressure should be lowered toless than 140/90 mm Hg in adults aged 60 to 79 years andto less than 150′90 mm Hg in adults aged 80 years and older.

  27. •• Rosendorff C, Lackland DT, Allison M, Aronow WS, Black HR, Blumenthal RS, et al. AHA/ACC/ASH scientific statement. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. J Am Coll Cardiol. 2015;65:1998–2038. These guidelines recommend that the blood pressure should bereduced to lessthan 140/90 mm Hg in patientswith coronary artery disease and with an acute coronary syndrome if they are aged 80 years and younger but to less than 150/90mm Hg if they are older than 80 years of age.

    Article  PubMed  Google Scholar 

  28. •• Padwal R, Rabi DM, Schiffrin EL. Recommendations for intensive blood pressure lowering in high-risk patients, the Canadian viewpoint. Hypertension. 2016;68:3–5. These Canadian guidelines recommend thathigh-risk adults aged 50 years and older with a systolic blood pressure of 130 mm Hg or higher obtained by an automated office blood pressure measurement should have a target systolic blood pressure goal of 120 mm Hg or lower.

    Article  CAS  PubMed  Google Scholar 

  29. •• Gabb GM, Mangoni A, Anderson CS, Cowley D, Dowden JS, Golledge J, et al. Guidelines for the diagnosis and management of hypertension in adults-2016. Med J Aust. 2016;205:85–9. These Australian guidelines state that selected high cardiovascular risk persons should havea systolic blood pressure goal of less than 120 mm Hg toimprove cardiovascular outcomes.

    Article  PubMed  Google Scholar 

  30. •• Qaseem A, Wilt TJ, Rich R, Humphrey LL, Frost J, Forciea MA, et al., for the Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American academy of Family Physicians. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Intern Med. 2017;166:430–7. Adults aged 60 years and older with a systolic blood pressure of 150 mm Hg and higher should have their systolic blood pressure reduced to less than 150 mm Hg.Adults aged 60 years and older with a history of stroke or transient ischemic attack should have their systolic blood pressure reduced to less than 140 mm Hg.Adults aged 60 years and older at high cardiovascular risk should have their systolic blood pressure reduced to less than 140 mm Hg.

  31. •• Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016;387:957–67. This meta-analysisdemonstrated thatevery 10 mm Hg reduction in systolic blood pressure significantly reduced major cardiovascular events by 20%, coronary heart disease by 17%, stroke by 27%, and heart failure by 28%, which in the populations studied reduced all-cause mortality by 13%.

    Article  PubMed  Google Scholar 

  32. Dahlöf B, Lindholm LH, Hansson L, Scherstén B, Ekbom T, Wester PO. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet. 1991;338:1281–5.

    Article  PubMed  Google Scholar 

  33. Working Party MRC. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ. 1992;304:405–12.

    Article  Google Scholar 

  34. Wittes J, Davis B, Berge K, Cohen JD, Grimm RH, Hawkins CM, et al. Systolic Hypertension of the Elderly Program (SHEP). Part 10: Analysis. Hypertension. 1991;17(3 Suppl):162–7.

    Google Scholar 

  35. Gueyffier F, Bulpitt C, Boissel JP, Schron E, Ekbom T, Fagard R, et al. Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group Lancet. 1999;353:793–6.

    Article  CAS  PubMed  Google Scholar 

  36. Bejan-Angoulvant T, Saadatian-Elahi M, Wright JM, Schron EB, Lindholm LH, Fagard R, et al. Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials. J Hypertens. 2010;28:1366–72.

    Article  CAS  PubMed  Google Scholar 

  37. •• Yano Y, Rakugi H, Bakris GL, Lloyd-Jones DM, Oparil S, Saruta T, et al. On-treatment blood pressure and cardiovascular outcomes in older adults with isolated systolic hypertension novelty and significance. Hypertension. 2017;69:220–7. In 3035 persons, mean age 76 years, with isolated systolic hypertension, a systolic blood pressureof 130 to 144mm Hg reduced at 3 years cardiovascular events and all-cause mortality.

    Article  CAS  PubMed  Google Scholar 

  38. Banach M, Bromfield S, Howard G, Howard VJ, Zanchetti A, Aronow WS, et al. Association of systolic blood pressure levels with cardiovascular events and all-cause mortality among older adults taking antihypertensive medication. Int J Cardiol. 2014;176:219–26.

    Article  PubMed  PubMed Central  Google Scholar 

  39. •• SPS3 Study Group, Benavente OR, Coffey CS, Conwitt R, Hart RG, McClure LA, et al. Blood-pressure targets in patients with recent lacunar stroke: the SPS3 randomised trial. Lancet. 2013;382:507–15. Compared to a systolic blood pressure of 138 mm Hg, a systolic blood pressure of 127 mm Hg in 3020 patients with recent lacunar strokenonsignificantly reduced at 3.7-year follow-up all stroke by 19%, disabling or fatal stroke by 19%, and myocardial infarction or vascular death by 16% and significantly reduced intracerebral hemorrhage by 63% (p =0.03).

    Article  Google Scholar 

  40. Oparil S. SPS3 evidence supports intensive blood pressure control. Circulation. 2016;133:552–4.

    PubMed  PubMed Central  Google Scholar 

  41. Bress AP, Tanner RM, Hess R, Colantonio LD, Shimbo D, Muntner P. Generizability of SPRINT results to the U.S. adult population. J Am Coll Cardiol. 2016;67:463–72.

    Article  PubMed  Google Scholar 

  42. •• Bress AP, Kramer H, Khatib R, Beddhu S, Cheung AK, Hess R, et al. Potential deaths averted and serious adverse events incurred from adoption of the SPRINT (Systolic Blood Pressure Intervention Trial) intensive blood pressure regimen in the United States. Projections from NHANES (National Health and Nutrition Examination Survey). Circulation. 2017;135:1617–28. This study reported that intensive lowering of systolic blood pressure of all eligible United States adults could prevent 107,500 deaths per year and 46,100 cases of heart failure per year but cause an increase in serious adverse events Z.

    Article  PubMed  Google Scholar 

  43. Lonn EM, Bosch J, Jaramillo PL, Zhu J, Liu L, Pais P, et al. Blood pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374:2009–20.

    Article  CAS  PubMed  Google Scholar 

  44. Whelton PK, Reboussin DM, Fine LJ. Comparing the SPRINT and the HOPE-3 blood pressure trial. JAMA Cardiol. 2016;1:855–856.1.

    Article  PubMed  Google Scholar 

  45. Oparil S, Lewis CE. Should patients with cardiovascular risk factors receive intensive treatment of hypertension to <120/80 mm target? A protagonist view from the SPRINT trial (Systolic Blood Pressure Intervention trial). Circulation. 2016;134:1208–310.

    Article  Google Scholar 

  46. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The JNC 7 Report. JAMA. 2003;289:2560–72.

    Article  CAS  PubMed  Google Scholar 

  47. Law MR, Morris JK, Wald NJ. Use of BP lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009;338:b1665. https://doi.org/10.1136/bmj.b1665.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering on outcome incidence in hypertension: 5. Head-to-head comparisons of various classes of antihypertensive drugs—overview and meta-analyses. J Hypertens. 2015;33:1321–41.

    Article  CAS  PubMed  Google Scholar 

  49. Marathe PH, Gao HX, Close KL. American Diabetes Association standards of medical care in diabetes 2017. J Diabetes. 2017;9:320–4.

    Article  PubMed  Google Scholar 

  50. Verbeke F, Lindley E, Van Bortel L, Vanholder R, London G, Cochat P, et al. A European renal best practice (ERBP) position statement on the kidney disease: improving global outcomes (KDIGO) clinical practice guideline for the management of blood pressure in non-dialysis-dependent chronic kidney disease: an endorsement with some caveats for real-life application. Nephrol Dial Transplant. 2014;29:490–6.

    Article  PubMed  Google Scholar 

  51. Aronow WS. Current role of beta blockers in the treatment of hypertension. Expert Opin Pharmacother. 2010;11:2599–607.

    Article  CAS  PubMed  Google Scholar 

  52. Aronow WS. Might losartan reduce sudden cardiac death in diabetic patients with hypertension? Lancet. 2003;362:591–2.

    Article  PubMed  Google Scholar 

  53. Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is it a wise choice? Lancet. 2004;364:1684–9.

    Article  CAS  PubMed  Google Scholar 

  54. Erikkson S, Olofsson BO, Wester PO. Atenolol in the secondary prevention after stroke. Cerebrovasc Dis. 1995;5:21–5.

    Article  Google Scholar 

  55. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes:UKPDS39. Br Med J. 1998;317:713–20.

    Article  Google Scholar 

  56. Rochlani Y, Khan MH, Banach M, Aronow WS. Are two drugs better than one? A review of combination therapies for hypertension. Expert Opin Pharmacother. 2017;18:377–86.

    Article  CAS  PubMed  Google Scholar 

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Rochlani, Y., Khan, M.H. & Aronow, W.S. Managing Hypertension in Patients Aged 75 Years and Older. Curr Hypertens Rep 19, 88 (2017). https://doi.org/10.1007/s11906-017-0785-3

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