Annals of Long Term Care

Challenges in Antihypertensive Therapy in Older Persons

Author: Dae Hyun Kim, MD, MPH

High blood pressure increases the risk of cardiovascular (CV) morbidity and mortality in a continuous fashion, even in very old adults. It is also associated with dementia and physical disability. Now it seems evident that treating stage 2 hypertension can reduce CV morbidity and mortality (especially stroke), and dementia to a modest degree in older adults. Although the HYpertension in the Very Elderly Trial was the first to report benefit of antihypertensive therapy in very old adults, the benefits of pharmacological treatment of uncomplicated stage 1 hypertension and lowering blood pressure below 140/90 mm Hg are not well established. In the future, trials of antihypertensive therapy should include functional outcomes, such as cognition, disability, gait impairment, and falls, which are as important as CV morbidity and mortality in older adults. This article summarizes the benefits and remaining challenges of antihypertensive therapy in older adults. (Annals of Long-Term Care: Clinical Care and Aging 2010;18[1]:27-32)

Benefits of Antihypertensive Therapy in Older Adults

High blood pressure is associated with cardiovascular (CV) morbidity and mortality,1 dementia,2 and disability.3 A number of randomized controlled trials of antihypertensive therapy have shown a significant reduction in CV morbidity and mortality in older adults. However, the treatment and control rates among hypertensive older adults have remained poor for the past decade,4 especially so in more advanced age.5 This is in part due to uncertainties from limited evidence to guide antihypertensive therapy in older adults with complex health problems.


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