Treatment of hypertension in the old and very old

Česká verzia

Authors: I. Řiháček
Authors place of work: II. interní klinika LF MU a FN U sv. Anny v Brně
Published in the journal: Kardiol Rev Int Med 2017, 19(2): 102-105

Summary

At present there are 1.93 million people aged over 65 years and 420,000 people aged over 80 years in the Czech Republic. Hypertension is one of the major risk factors of cardiovascular disease. Its prevalence increases with age and so does the number of other risk factors and comorbidities. Hypertension is characterised by reduced elasticity of large arteries and increased systolic and pulse pressure. The target levels of blood pressure are below 140/ 90 mmHg for persons aged 65– 80, and below 150/ 90 mmHg in persons over 80 years. All five recommended groups of drugs are used in the treatment, preferably at lower doses and in fixed combinations. Diuretics and long-acting calcium channel blockers are most effective in reducing systolic and pulse pressure. An appropriate treatment of hypertension reduces the incidence of cardiovascular events and prolongs active life in the elderly.

Keywords:
hypertension – the old and very old – demography – pathophysiology – cardiovascular risk – treatment

Zdroje

1. Ústav zdravotnických informací a statistiky. Ročenka 2015, Praha. Dostupné z: http:/ / www.uzis.cz/ katalog/ rocenky/ zdravotnicka-rocenka-ceske-republiky 2015.

2. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ ESC guidelines for the management of arterial hypertension. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J2013; 34(28): 2159– 2219. doi: 10.1093/ eurheartj/ eht151.

3. Filipovský J, Widimský J jr, Ceral J et al. Diagnostické a léčebné postupy u arteriální hypertenze – verze 2012. Doporučení České společnosti pro hypertenzi. Vnitř Lék 2012; 58(10): 785– 801.

4. Burt VL, Whelton P, Roccella EJ at al. Prevalence of hypertension in the us adult population: results from the Third National Health and Nutrition Examination Survey, 1988– 1991. Hypertension 1995; 25(3): 305– 313. doi: 10.1161/ 01.HYP.25.3.305.

5. Kannel WB, Wolf PA, McGee DL et al. Systolic blood pressure, arterial rigidity and stroke. The Framingham study. JAMA 1981; 245(1): 1225– 1228. doi: 10.1001/ jama.1981.03310370017013.

6. Dart AM, Kingwell BA. Pulse pressure– a review of mechanism and clinical relevance. J Am Coll Cardiol 2001; 37(4): 975– 984.

7. Millar JA, Lever AF. Implications of pulse pressure as a predictor of cardiac risk in patients with hypertension. Hypertension 2000; 36(5): 907– 911. doi: 10.1161/ 01.HYP.36.5.907.

8. Mitchell GF, Vasan RS, Keyes MJ et al. Pulse pressure and risk of new-onset atrial fibrillation. JAMA 2007; 297(7): 709– 715. doi: 10.1001/ jama.297.7.709.

9. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA 1991; 265(24): 3255– 3264. doi: 10.1001/ jama.1991.03460240051027.

10. Staesen NJ, Fagard R, Thijs L et al. Morbidity and mortality in the placebo controlled European trial on isolated systolic hypertension in the elderly. Lancet 1997; 350(9080): 757– 764. doi: 10.1016/ S0140-6736(97)05381-6.

11. Beckett NS, Peters R, Fletcher AE et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358(18): 1887– 1898. doi: 10.1056/ NEJMoa0801369.

12. Pickering TG, Hall JE, Appel LJ et al. Recommendations for blood pressure measurement in humans: an AHA scientific statement from the Council on High Blood Pressure Research Professional and Public Education Subcommittee. J Clin Hypertens 2005; 7(2): 102– 109. doi: 10.1111/ j.1524-6175.2005.04377.x.

13. Wang GJ, Staesen JA, Gong L et al. Chinese trial of isolated systolic hypertension in the elderly. Arch Intern Med 2000; 160(2): 211– 220. doi: 10.1001/ archinte.160.2.211.

14. Dahlof B, Lindholm LH, Hansson L et al. Morbidity and mortality in the Swedish trial in old patients with hypertension (STOP-Hypertension). Lancet 1991; 338(8778): 1281– 1285. doi: 10.1016/ 0140-6736(91)92589-T.

15. MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1992; 304(6824): 405– 412. doi: 10.1136/ bmj.304.6824.405.

16. Patel A, MacMahon S, Chaimers J et al. ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370(9590): 829– 840. doi: 10.1016/ S0140-6736(07)61303-8.

17. PROGRESS Collaborative Group. Randomized trial of a perindopril-based blood blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. Lancet 2001; 358(9287): 1033– 1041 doi: 10.1016/ S0140-6736(01)06178-5.

18. Fox KM. The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362/ 9386): 782– 788. doi: 10.1016/ S0140-6736(03)14286-9.