Treatment of Hypertension in Older People

Hypertension is a very common condition in old age. Choosing treatment for this age group is different from doing it for young people. Let's see the reasons and what options are available.
Treatment of Hypertension in Older People

Last update: 18 August, 2021

High blood pressure increases as you get older. According to estimates by the American College of Cardiology (ACC), up to 70% of adults over 65 have hypertension. Due to several factors, the treatment of hypertension in older people is different from that of young adults or adolescents.

Given the risk of heart failure, cardiovascular attacks, and kidney failure, among other things, it’s urgent to provide a safe and effective therapy to control blood pressure levels. Today we review some fundamental criteria that are taken into account when choosing the best alternative for this age range.

Treatment of hypertension in older people

Treatment of hypertension in older people can be complex
Older adults tend to have more comorbidities, which can complicate the therapeutic strategy to control high blood pressure.

The complications related to increased blood pressure become greater as you age. Several elements that contribute to these imbalances have been identified., Among them, we mainly find arterial stiffness, dysregulation and deterioration of kidney function, hemodynamic changes at a mechanical level, and neurohormonal disorders.

It’s because of all this that the chances of developing the disease increase with age, which, in turn, creates several challenges. Research has suggested five of the most serious areas when treating hypertension in older adults:

  1. Cognitive impairment
  2. Multimorbidity
  3. Fragility
  4. Orthostatic hypotension
  5. Increased risk of falls

Any therapy that’s aimed at treating the condition in people over 65 must take this into account, since the dose, frequency, type of medication and expectations are conditioned by the previous criteria. Many times these conditions overlap each other, forcing the specialist to be more careful during the process.

There’s no standard value for what the range of blood pressure should be in older adults. It has been suggested that it should be around 140/90 mmHg.

However, many patients don’t tolerate it well, as the decrease is accompanied by an increased risk of falls when you also have orthostatic hypotension. That’s why experts recommend that you need to find the dosis that your body tolerates.

As we can see, both the values and the objectives are different during the treatment of older hypertensive patients in contrast to younger populations. The therapy is chosen according to the severity, as in patients with resistant hypertension it’s more difficult to control.

Lifestyle changes as treatment for the elderly hypertensive

A change in lifestyle is part of a conservative treatment in the management of hypertension in older people. Therefore, applying certain modifications in your day-to-day habits is the first step to balance pressure values, regardless of whether medication is also prescribed.

Multiple investigations and studies have highlighted the importance of programs aimed at reducing the factors associated with increased blood pressure. Among the most important we can highlight:

  • Doing physical activity: In order to do this, you can follow the recommendations of the World Health Organization (WHO) of around 160 minutes of aerobic exercise a week.
  • Reducing sodium intake: Lowering sodium intake in older adults has been shown to help stabilize blood pressure values.
  • Losing weight: Even when it’s not so substantial, the evidence indicates that losing weight can have a part to play in improving the prognoses and control of the disease, as well as the reduction of conditions related to it.
  • Quitting smoking: Smoking is an old enemy of blood pressure, regardless of age. Given the conditions, research suggests a closer relationship and a higher risk of death in old age.
  • Reducing stress levels: This has been shown to minimize stress episodes and is, therefore, useful for treating blood pressure in the elderly. It must therefore be part of the therapy to control the disease.

These are the basic recommendations that the doctor will suggest, although they’ll also be accompanied by others according to each individual case. These habits alone rarely keep high pressure levels down on their own, but they certainly complement the assimilation of administered drug therapy.

Pharmacological treatment for hypertension in older adults

Treatment of hypertension in older people includes the use of drugs
Most antihypertensive medications can be used in older people. However, the higher incidence of kidney and liver failure can lead to some restrictions.

There’s no age limit for the intake of antihypertensive drugs in older adults, as the evidence indicates. However, you must make this choice in a controlled manner, monitoring the degree of tolerance and the possible side effects it produces in the patient.

Research published in the journal The BMJ in 2008 suggested that there’s not a big difference between the groups of drugs given to older adults in the development of major cardiovascular events related to hypertension.

This indicates that thiazide diuretics, calcium channel blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors are just as effective in adulthood.

Perhaps the exception here is beta-blockers, which, according to some evidence, are less effective than diuretics in treating blood pressure in older adults. Because of this, the latter are the first option that the specialist will use to control tension levels.

You need a fair amount of trial and error that will take into account adverse effects, the degree of acceptance by the body, and the interaction with other drugs. All of this will determine which is the best option for the patient. For this reason, it may take several weeks or months to find the therapy that best fits the context.

  • Al-Wehedy, A., Abd Elhameed, S. H., & Abd El-Hameed, D. Effect of lifestyle intervention program on controlling hypertension among older adults. Journal of Education and Practice. 2014; 5(5): 61-71.
  • Anandita, M. D., Mehta, A., Yang, E., & Parapid, B. M. Older Adults and Hypertension: Beyond the 2017 Guideline for Prevention, Detection. Evaluation, and Management of High Blood Pressure in Adults. 2020; 26.
  • Conroy, S. P., Westendorp, R. G. J., & Witham, M. D. Hypertension treatment for older people—navigating between Scylla and Charybdis. Age and ageing. 2018; 47(4): 505-508.
  • Kakavand, A., & Damercheli, N. The role of mediator of perceived stress in the relationship between personality traits and hypertension among the elderly. Aging Psychology. 2017: 2(4): 271-279.
  • Messerli, F. H., Grossman, E., & Goldbourt, U. Are β-blockers efficacious as first-line therapy for hypertension in the elderly?: a systematic review. Jama. 1998; 279(23): 1903-1907.
  • Nguyen, Q. T., Anderson, S. R., Sanders, L., & Nguyen, L. D. Managing hypertension in the elderly: a common chronic disease with increasing age. American health & drug benefits. 2012; 5(3): 146.
  • Oliveros, E., Patel, H., Kyung, S., Fugar, S., Goldberg, A., Madan, N., & Williams, K. A. Hypertension in older adults: Assessment, management, and challenges. Clinical cardiology. 2020; 43(2): 99-107.
  • Parekh, N., Page, A., Ali, K., Davies, K., & Rajkumar, C. A practical approach to the pharmacological management of hypertension in older people. Therapeutic advances in drug safety. 2017; 8(4): 117-132.
  • Somes, G. W., Kritchevsky, S. B., Shorr, R. I., Pahor, M., & Applegate, W. B. Body mass index, weight change, and death in older adults: the systolic hypertension in the elderly program. American journal of epidemiology. 2002; 156(2): 132-138.
  • Trialists’Collaboration, B. P. L. T. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. Bmj. 2008; 336(7653): 1121-1123.
  • Umpierre, D., Santos, L. P., Botton, C. E., Wilhelm, E. N., Helal, L., Schaun, G. Z., … & Pinto, S. S. The “Hypertension Approaches in the Elderly: a Lifestyle study” multicenter, randomized trial (HAEL Study): rationale and methodological protocol. BMC public health. 2019; 19(1): 1-13.
  • Wang, Y., Zheng, X., Zhang, C., Yang, Y., Liu, L., Qi, Y., & Bu, P. A12426 Association between smoking and blood pressure in elderly male patients with essential hypertension. Journal of Hypertension. 2018; 36: 321.
  • Whelton, P. K., Appel, L. J., Espeland, M. A., Applegate, W. B., Ettinger Jr, W. H., Kostis, J. B., … & TONE Collaborative Research Group. Sodium reduction and weight loss in the treatment of hypertension in older persons: a randomized controlled trial of nonpharmacologic interventions in the elderly (TONE). Jama. 1998; 279(11): 839-846.

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