Hypertension in the frail elderly.
Extant data indicate that treating to lower systolic pressure confers significant advantage to younger people in general good health and to relatively healthy octogenarians. Few data exist to guide practitioners on the treatment of frail elderly hypertensives. Chronological age alone does not suffice to make useful judgments regarding therapy. The definition of frailty remains controversial. One method, use of a simple questionnaire or a test of walking speed is practical but not universally accepted. Frail subjects, while at higher risk for cardiovascular complications, seem to benefit less or not at all from antihypertensive drug treatment. Clinicians should treat robust older patients as they would younger patients because the benefits far outweigh the low risk of adverse effects. Successful antihypertensive therapy in those younger than 80 years should not be discontinued simply because that age milestone has been crossed. Treatment of frail older patients must be individualized. Some frail survivors age 80 years or older may actually fare better with elevated systolic pressures. Pending the cognitive function substudy of Systolic Blood Pressure Intervention Trial, there is little evidence that antihypertensive treatment benefits established cognitive dysfunction. Because hypertension in middle age is a good predictor of later cognitive dysfunction, the clinical approach should be one of early prevention.
Division of Clinical Pharmacology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address: bmaterson@med.miami.edu.
Barry J
BJ
Materson
Nephrologist, Miami, FL, USA.
Manuel
M
Garcia-Estrada
Chief Division of Clinical Pharmacology, Clinical Pharmacology Research Unit (CPRU), Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Cellular Biology and Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
Richard A
RA
Preston
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure; D001795:Blood Pressure Determination; D002318:Cardiovascular Diseases / Q000139:chemically induced; D060825:Cognitive Dysfunction / Q000517:prevention & control; D016330:Frail Elderly; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D057285:Precision Medicine / Q000379:methods*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D000072797:Walking Speed; D028761:Withholding Treatment
D000959:Antihypertensive Agents
Drug treatment; elderly; frail; hypertension