| Current approaches to the treatment of hypertension in older persons. | |
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MedLine Citation:
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PMID: 22314114 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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Hypertension is a major risk factor for cardiovascular disease and is present in 69% of patients with a first myocardial infarction, in 77% of patients with a first stroke, in 74% of patients with chronic heart failure, and in 60% of patients with peripheral arterial disease. Double-blind, randomized, placebo-controlled trials have demonstrated that antihypertensive drug therapy reduces cardiovascular events in patients aged 65 to 79 years. In the Hypertension in the Very Elderly Trial, patients aged ≥ 80 years who were treated with antihypertensive drug therapy had, at 1.8-year follow-up, a 30% reduction in fatal or nonfatal stroke (P = 0.06), a 39% reduction in fatal stroke (P = 0.05), a 21% reduction in all-cause mortality (P = 0.02), a 23% reduction in cardiovascular death (P = 0.06), and a 64% reduction in heart failure (P < 0.001). Although the optimal blood pressure (BP) treatment goal in the elderly has not been determined, existing epidemiologic and clinical trial data suggest that a reasonable therapeutic BP goal should be < 140/90 mm Hg in persons aged < 80 years and a systolic BP of 140 to 145 mm Hg if tolerated in persons aged ≥ 80 years. Nonpharmacologic lifestyle measures should be encouraged both to prevent development of hypertension and as adjunctive therapy in persons with hypertension. Diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and calcium channel blockers have all shown benefit in reducing cardiovascular events in randomized trials. The choice of specific drugs depends on efficacy, tolerability, presence of specific comorbidities, and cost. Adverse effects from treatment, such as electrolyte disturbances, renal dysfunction, and excessive orthostatic BP reduction, should be avoided. |
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Authors:
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Wilbert S Aronow |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Postgraduate medicine Volume: 124 ISSN: 1941-9260 ISO Abbreviation: Postgrad Med Publication Date: 2012 Jan |
Date Detail:
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Created Date: 2012-02-08 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0401147 Medline TA: Postgrad Med Country: United States |
Other Details:
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Languages: eng Pagination: 50-9 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Division of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Valhalla, NY. wsaronow@aol.com. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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