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Hypertension therapy in the older adults—do we know the answers to all the questions? The status after publication of the ACCF/AHA 2011 expert consensus document on hypertension in the elderly

Journal of Human Hypertension volume 26, pages 641–643 (2012)Cite this article

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In Europe the average life expectancy at birth has risen from around 45 years in the 1900s to 65.6 years in 1950 to 1955 to 75.1 years in 2005 to 2010, and in the EU27 it is expected to rise to 85.3 years for women and 80.0 years for men.1, 2 An equally important fact is that the number of Europeans aged 65+ is expected to increase by 45% between 2008 and 2030, and even further to over 30% of the population by 2060.1, 2 The same situation concerns the United States, Japan and other countries. Therefore, currently we face the challenge to not only increase the length of life but also to improve the quality of therapy and in consequence the quality of life. Activities should be focused especially on several areas, including hypertension (HTN) as one of the first, which is connected with the fact that HTN is one the leading cause of mortality and the third cause of disability.3, 4, 5 About 54% of strokes and 47% of ischemic heart diseases worldwide are attributable to high blood pressure (BP), and HTN is present in approximately 69% of patients with a first myocardial infarction, in approximately 77% of patients with a first stroke, in approximately 74% of patients with chronic heart failure and in 60% of patients with peripheral arterial disease.3, 4, 5, 6, 7

In recent years, there has been extensive discussion on the effective treatment of HTN in the elderly population. Until a few years ago we did not know how to treat them, what should be the optimal levels of BP in these patients, what drugs are the most effective and have the fewest therapy-associated adverse events, and how our HTN therapy should really prevent HTN complications, reduce mortality and improve the quality of life. For the first time, in the early 1980s, and then in the 1990s and later, a number of trials and meta-analyses were performed and proved that active treatment of HTN with most available antihypertensive drugs in individuals above the age of 60–65 years, as compared with placebo or no treatment, significantly reduces the risk of complications.7, 8, 9 In the 1990s, the same was proven in patients specifically affected with isolated systolic HTN—the predominant form of HTN in the older adults.8 The HYpertension in the Very Elderly Trial (HYVET) confirmed the necessity of optimal HTN therapy in elderly patients, even at age 80 or older.10 In the HYVET trial, 3845 individuals aged 80 years and older (mean age 83.6 years) with a sustained systolic BP (SBP) of 160 mm Hg or higher were randomized to indapamide at dose 1.5 mg or matching placebo. Perindopril 2 mg or 4 mg, or matching placebo, was added if needed to achieve the target BP of 150/80 mm Hg. The study was terminated early after a median follow-up of 1.8 years. The authors showed that antihypertensive drug therapy significantly decreased the incidence of the primary endpoint (fatal or nonfatal stroke) by 30% (P=0.06). It also essentially reduced fatal stroke by 39% (P=0.05), all-cause mortality by 21% (P=0.02), death from cardiovascular (CV) causes by 23% (P=0.06) and heart failure by 64% (P<0.001).10 We should emphasize the significant 21% reduction in all-cause mortality by antihypertensive drug treatment, which was unexpected. What is more, the benefits of therapy still appeared during the first year of follow-up.8, 10, 11 However, the trial, like the previous ones, did not answer the important question regarding the target BP in this population.10, 11

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References

  1. Eurostat 2010. http://epp.eurostat.ec.europa.eu/cache/ITY_PUBLIC/1-05032010-AP/EN/1-05032010-AP-EN.PDF.

  2. Leis M, Gijsbers G . Report on Active and Healthy Ageing – A Long-term View up to 2050. Updated with results from the expert workshop on ‘Active and Healthy Ageing’. 31.01.2011, Brussels. European Foresight Platform, 2011.

  3. Global Health Risks. Mortality and Burden of Disease Attributable to Selected Major Risks. World Health Organization, 2009. Geneva, Switzerland. http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf.

  4. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K et al. Heart disease and stroke statistics - 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119: e21–181.

    Google Scholar 

  5. Chockalingam A, Campbell NR, Fodor JG . Worldwide epidemic of hypertension. Can J Cardiol 2006; 22: 553–555.

    Article  Google Scholar 

  6. Sethi A, Arora RR . Ambulatory blood pressure as a predictor of cardiovascular risk. Arch Med Sci 2009; 5: 3–9.

    Google Scholar 

  7. Bielecka-Dabrowa A, Aronow WS, Rysz J, Banach M . The Rise and Fall of Hypertension: Lessons learned from Eastern Europe. Curr Cardiovasc Risk Rep 2011; 5: 174–179.

    Article  Google Scholar 

  8. Aronow WS . Why and how we should treat elderly patients with hypertension? Curr Vasc Pharmacol 2010; 8: 780–787.

    Article  CAS  Google Scholar 

  9. Butt TF, Branch RL, Beesley L, Martin U . Managing hypertension in the very elderly: effect of adverse drug reactions (ADRs) on achieving targets. J Hum Hypertens 2010; 24: 514–518.

    Article  CAS  Google Scholar 

  10. 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: 1887–1898.

    Article  CAS  Google Scholar 

  11. Szucs TD, Waeber B, Tomonaga Y . Cost-effectiveness of antihypertensive treatment in patients 80 years of age or older in Switzerland: an analysis of the HYVET study from a Swiss perspective. J Hum Hypertens 2010; 24: 117–123.

    Article  CAS  Google Scholar 

  12. Banach M, Rysz J . Current problems in hypertension and nephrology. Expert Opin Pharmacother 2010; 11: 2575–2578.

    Article  Google Scholar 

  13. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009; 27: 2121–2158.

    Article  CAS  Google Scholar 

  14. JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res 2008; 31: 2115–2127.

    Article  Google Scholar 

  15. 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. Circulation 2011; 123: 2434–2506.

    Article  Google Scholar 

  16. Campbell P, Ghuman N, Wakefield D, Wolfson L, White WB . Long-term reproducibility of ambulatory blood pressure is superior to office blood pressure in the very elderly. J Hum Hypertens 2010; 24: 749–754.

    Article  CAS  Google Scholar 

  17. Vulic D, Loncar S, Krneta M et al. Risk factor control and adherence to treatment in patients with coronary heart disease in the Republic of Srpska, Bosnia and Herzegovina in 2005-2006. Arch Med Sci 2010; 6: 270–275.

    Google Scholar 

  18. Antikainen RL, Kastarinen MJ, Jousilahti P, Peltonen M, Laatikainen T, Beckett N et al. Despite evidence-based guidelines, systolic blood pressure remains inadequately controlled in older hypertensive adults. J Hum Hypertens 2010; 24: 439–446.

    Article  CAS  Google Scholar 

  19. Fleg JL, Aronow WS, Frishman WH . Cardiovascular drug therapy in the elderly: benefits and challenges. Nat Rev Cardiol 2011; 8: 13–28.

    Article  CAS  Google Scholar 

  20. Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. Br Med J 2008; 336: 1121–1123.

    CAS  Google Scholar 

  21. Bielecka-Dabrowa A, Aronow WS, Rysz J, Banach M . Current place of beta-blockers in the treatment of hypertension. Curr Vasc Pharmacol 2010; 8: 733–741.

    Article  CAS  Google Scholar 

  22. Siscovick DS, Raghunathan TE, Psaty BM, Koepsell TD, Wicklund KG, Lin X et al. Diuretic therapy for hypertension and the risk of primary cardiac arrest. N Engl J Med 1994; 330: 1852–1857.

    Article  CAS  Google Scholar 

  23. Bielecka-Dabrowa A, Mikhailidis DP, Jones L, Rysz J, Aronow WS, Banach M . The meaning of hypokalemia in heart failure. Int J Cardiol (e-pub ahead of print 18 July 2011; doi:10.1016/j.ijcard.2011.06.121).

    Article  Google Scholar 

  24. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL 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: 2560–2572.

    Article  CAS  Google Scholar 

  25. Banach M, Michalska M, Kjeldsen SE, Malyszko J, Mikhailidis DP, Rysz J . What should be the optimal levels of blood pressure: does the J-curve phenomenon really exist? Expert Opin Pharmacother 2011; 12: 1835–1844.

    Article  Google Scholar 

  26. Denardo SJ, Gong Y, Nichols WW, Messerli FH, Bavry AA, Cooper-Dehoff RM et al. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy. Am J Med 2010; 123: 719–726.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland

    M Banach

  2. Department of Medicine, New York Medical College, Valhalla, NY, USA

    W S Aronow

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Banach, M., Aronow, W. Hypertension therapy in the older adults—do we know the answers to all the questions? The status after publication of the ACCF/AHA 2011 expert consensus document on hypertension in the elderly. J Hum Hypertens 26, 641–643 (2012). https://doi.org/10.1038/jhh.2012.3

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