Hypertension in the Elderly

Springer Science and Business Media LLC - Tập 22 - Trang 297-314 - 2012
Toshio Ogihara1, Hiromi Rakugi1
1Department of Geriatric Medicine, Osaka University Graduate School of Medicine, Suita, Japan

Tóm tắt

Elderly individuals with hypertension show specific characteristics as a result of advancing arteriosclerosis, a high frequency of isolated systolic hypertension, increased pulse pressure and orthostatic hypotension. The necessity to treat hypertension in the elderly, including isolated systolic hypertension, has been demonstrated in many large-scale intervention trials. Young-old (65–74 years of age) hypertensive patients should be treated the same as nonelderly hypertensive patients. In old-old (75–84 years of age) patients with mild hypertension (140–159/90–99mm Hg), the recommended target blood pressure (BP) is <140/90mm Hg. In old-old (75–84 years of age) and oldest-old (≥85 years of age) patients with systolic BP ≥160mm Hg, cautious treatment is required. An intermediate target BP of <150mm Hg is appropriate, followed by a final target BP of <140mm Hg, if tolerated. Nonmedical therapy, such as salt restriction, exercise and weight reduction, is useful in the elderly. However, individualised management of nonmedical therapy is necessary to avoid deterioration of quality of life resulting from strict management of the patient’s lifestyle. Diuretics, calcium channel antagonists, ACE inhibitors and angiotensin II type 1 receptor antagonists have been established as first-line antihypertensive drugs in the elderly. Use of combination therapy helps to achieve target BPs. The starting dose of each drug should be half the usual dose for nonelderly patients, and may be increased at intervals of >4 weeks, with achievement of the target BP in 3–6 months or longer. In hypertensive patients with co-morbid diseases, the target BP should be determined individually and antihypertensive drugs selected bearing in mind the patient’s clinical circumstances. Avoiding hypoperfusion of target organs is very important in elderly hypertensive patients. When treating hypertension in elderly patients, the approach should be to identify individual pathophysiological characteristics and lower the BP cautiously and slowly.

Tài liệu tham khảo

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