In a nutshell
This paper studied the management of high blood pressure in patients aged 80 years and above.
Some background
The number of patients older than 80 years is expanding faster than any other age group. These patients are more likely to have other illnesses and be frail (living in nursing homes or needing assistance for basic living). These patients have different needs from younger patients. Experts from the European Society of Hypertension, the European Society of Cardiology, and the European Union Geriatric Medicine Society developed guidelines for the treatment of high blood pressure in patients aged 80 and above.
Methods & findings
Frail older patients are not just at risk of high blood pressure, but also of low blood pressure. Low blood pressure increases their risk of falls. Based on the study, it is suggested that older patients with a systolic blood pressure of 150 mmHg and above should be started on medication. However, the evidence was not strong and it is unclear if patients with a systolic blood pressure of 140 mmHg-159 mmHg can benefit from medication. It is also unclear what the target blood pressure should be. Thus the authors suggest that blood pressure drugs should be reduced or stopped if the systolic blood pressure drops below 130 mmHg. The target blood pressure is suggested to be between 130 mmHg and 150 mmHg.
The use of beta-blockers (group of drugs used for high blood pressure) remains controversial in very old patients with high blood pressure. Angiotensin-converting enzyme inhibitors, diuretics and calcium channel blockers are recommended. A combination of 2 drugs should be considered if a single drug fails to control blood pressure, but only if the benefits outweighs the risks.
The authors suggest that in frail older patients, their ability to carry out tasks and thinking should be assessed. An estimate of their prognosis is also useful. Their risk factors and degree of frailty should also be identified.
The bottom line
The authors concluded that frail older patients require different treatment strategies.
The fine print
The authors gave suggestions, but more evidence is needed to back up these suggestions.
Published By :
Hypertension
Date :
Mar 14, 2016
