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Management of hypertension in the elderly

Nature Reviews Cardiology volume 9, pages 286–296 (2012)Cite this article

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Abstract

Hypertension is the most-prevalent modifiable risk factor for cardiovascular morbidity and mortality worldwide. Hypertension is highly prevalent among older adults (≥65 years), and aging of the population will substantially increase the prevalence of this condition. Age-related endothelial dysfunction and increased arterial stiffness contribute to the increased prevalence of hypertension, particularly systolic hypertension, among the elderly. The incidence of some forms of secondary hypertension also increases with age, mainly owing to the use of drugs (especially NSAIDs that have pressor effects) and the presence of chronic kidney disease, obstructive sleep apnea, and renal artery stenosis. Guidelines differ in thresholds and goals for antihypertensive drug therapy in the elderly because of a paucity of high-level evidence from randomized controlled trials and inconsistencies in the definition of 'elderly'. Medical treatment of hypertension reduces cardiovascular morbidity and mortality in the elderly, and all guidelines recommend lifestyle modifications and medical treatment for elderly patients whose blood pressure exceeds prescribed thresholds and who are at moderate or high cardiovascular disease risk. In the absence of comorbidities, which constitute 'compelling indications' for the use of specific antihypertensive drugs or drug classes, no clear evidence exists to support recommendations for the use of particular antihypertensive-drug classes in older adults.

Key Points

  • Hypertension is highly prevalent among older adults (≥65 years), and aging of the population will substantially increase the prevalence of this condition worldwide

  • Increased arterial stiffness, which is commonly found in elderly individuals, contributes to systolic hypertension and wide pulse pressure, in part by increasing pulse wave velocity

  • Medical treatment of hypertension in older adults reduces cardiovascular morbidity and mortality

  • No clear evidence exists to support recommendations for the use of particular drug classes in older adults

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Figure 1
Figure 2: Distensibility and pulse wave velocity.
Figure 3: Algorithm for treatment of hypertension in the elderly according to the 2011 NICE guideline recommendations.75

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Authors and Affiliations

  1. Endocrine Hypertension Research Centre and Clinical Centre of Research Excellence in Cardiovascular Disease and Metabolic Disorders, University of Queensland School of Medicine, Princess Alexandra Hospital, 5th Floor, Ipswich Road, Woolloongabba, Brisbane, QLD 4102, Australia

    Eduardo Pimenta

  2. Division of Cardiovascular Disease, Department of Medicine, Vascular Biology and Hypertension Program, University of Alabama at Birmingham, 703 19th Street South, ZRB 1034, Birmingham, 35294, AL, USA

    Suzanne Oparil

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Both authors researched data for the article, contributed to the discussion of the content, wrote the article, and reviewed/edited the manuscript before submission.

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Correspondence to Eduardo Pimenta.

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Competing interests

S. Oparil has received research support from Merck and Co., Novartis, and Takeda; honoraria from Daiichi Sankyo and Pfizer; and has acted as a consultant/Advisory Board member for Bayer, Daiichi Sankyo, Medtronic, Novartis, and Pfizer. In addition she was Co-Chair of the Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC8). E. Pimenta declares no competing interests.

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Pimenta, E., Oparil, S. Management of hypertension in the elderly. Nat Rev Cardiol 9, 286–296 (2012). https://doi.org/10.1038/nrcardio.2012.27

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