Hypertension management in the elderly and the very elderly.
Hypertension management in the elderly and the very elderly.
Where did the research take place?
The study site has not been established. Author addresses may differ from where the research occurred.
Varese, IT · Author affiliation
Department of Medicine and Surgery, University of Insubria, Via Guicciardini 5, 21100 Varese, Italy.Location evidence
Pavia, IT · Author affiliation
Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy.Location evidence
Florence, IT · Author affiliation
Department of Experimental and Clinical Medicine, Geriatric Intensive Care Unit and Geriatric Arrhythmia Unit, University of Florence and AOU Careggi, 50134 Florence, Italy.Location evidence
Lyon, FR · Author affiliation
Department of Cardiology and Vascular Pathology, CH Saint Joseph and Saint Luc, 69000 Lyon, France.Location evidence
Turin, IT · Author affiliation
Cardiology, Poliambulatori Gruppo LARC-Laboratorio Analisi e Ricerca Clinica, 10100 Turin, Italy.Location evidence
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Original abstract
Hypertension increases with age, with a very high prevalence in older patients. Since hypertension is a major contributor of cardiovascular diseases, this condition accounts for the majority of stroke and a relevant number of coronary artery disease cases in the older adults. Ageing is associated with frailty and multi-morbidity, often associated with poly-pharmacy, which may complicate the management of hypertension. Specific diseases like diabetes and Parkinson disease associated with autonomic dysfunctions, and the frail condition, should be carefully considered in order to avoid orthostatic hypotension. Aortic stenosis, cardiac hypertrophy, heart failure, reduced glomerular filtration rate, arrhythmias such as atrial fibrillation, obstructive coronaropathies, and cerebral vascular lesions constitute haemodynamic challenges and may be associated with increased adverse effects during anti-hypertensive treatments. Moreover, specific drugs and drug-drug interactions are associated with side-effects particularly deleterious in the older patients. The worsening of the state of health and the increase in the degree of frailty can result either as a consequence of target organ damage related to hypertension or caused by anti-hypertensive drugs. Therefore, in the older adults, a careful assessment of the individual risk/benefit profile and a personalized view of the patient are necessary to establish the appropriate blood pressure targets and the appropriate treatments.