HYPERTENSION IN THE ELDERLY: CHALLENGES IN MANAGEMENT AND TREATMENT
DOI:
https://doi.org/10.29121/granthaalayah.v12.i9.2024.5769Keywords:
Hypertension, Management, Lifestyle ModificationsAbstract [English]
Hypertension is a prevalent and significant health issue among the elderly, contributing to increased risks of cardiovascular diseases, stroke, and kidney failure. Managing hypertension in older adults poses unique challenges due to age-related physiological changes, comorbidities, and polypharmacy. This review explores the complex pathophysiology of hypertension in the elderly, including age-related changes in vascular function and the impact of comorbid conditions. It examines the difficulties in diagnosing hypertension, such as variability in blood pressure readings, white coat syndrome, and masked hypertension, highlighting the need for accurate monitoring through home and ambulatory techniques. The review discusses current management strategies, emphasizing the importance of setting appropriate treatment goals, implementing lifestyle modifications, and utilizing pharmacological treatments, including new antihypertensive drugs and combination therapies. It also addresses challenges such as adverse drug reactions, medication adherence, and the management of polypharmacy. Recent advances, including innovations in drug delivery systems and digital health technologies, offer promising solutions for improving hypertension management. Future research directions include exploring precision medicine, understanding the role of the gut microbiome, and addressing health disparities. Clinicians are advised to adopt personalized treatment approaches, integrate technological tools, and address socioeconomic barriers to optimize hypertension management in the elderly. This review underscores the need for ongoing research and tailored strategies to improve outcomes and quality of life for older patients with hypertension.
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References
Agarwal S, Kolb T, Wright J, et al. (2017) Financial Barriers to Medication Adherence Among Older Adults: A Systematic Review. J Geriatr Pharmacother. 15(3) :159-72.
Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, et al. (1997) A Clinical Trial of the Effects of Dietary Patterns on Blood Pressure. DASH Collaborative Research Group. N Engl J Med. ;336(16):1117-24. https://doi.org/10.1056/NEJM199704173361601
Aronow WS, Fleg JL. (2017) Blood Pressure Targets in Older Adults with Hypertension : a Comprehensive Review. Ann Transl Med. 5(3) :59.
Aronow WS. (2011) Hypertension and Kidney Disease in the Elderly. J Hypertens.;29(2) :251-2.
Bakris GL, Williams M, Dworkin L, et al. (2014) Preserving Renal Function in Adults with Hypertension and Diabetes: a Consensus Approach. Am J Kidney Dis. ;64(5):716-24.
Beers MH, Ouslander JG, Rollingher I, Reuben DB, Liebmann PJ, Philips AL. (1991) Explicit Criteria for Determining Inappropriate Medication use in Nursing Home Residents. UCLA Division of Geriatric Medicine. Fed Regist. 56(187):55535-9.
Benetos A, Petrovic M, Strandberg T.(2019).Hypertension Management in Older and Frail Older Patients. Circ Res. 124(7):1045-60. https://doi.org/10.1161/CIRCRESAHA.118.313236
Benetos A, Safar M, Rudnichi A, Smulyan H, Richard JL, Ducimetiere P, et al. (1997).Pulse Pressure : a Predictor of Long-Term Cardiovascular Mortality in a French male population. Hypertension. 30(6):1410-5. https://doi.org/10.1161/01.HYP.30.6.1410
Bennett JS, Dodd MA, McClaran J, et al. (2014) Medication Adherence in Elderly Patients with Hypertension : a Review of the Literature. J Clin Hypertens (Greenwich). 16(12) :924-32.
Carretero OA, Oparil S. (2000) Essential Hypertension. Part I: Definition and Etiology. Circulation. ;101(3):329-35. https://doi.org/10.1161/01.CIR.101.3.329
Clement DL, De Buyzere ML, De Bacquer DA, de Leeuw PW, Duprez DA, Fagard RH, et al. (2003) .Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension. N Engl J Med. 348(24):2407-15. https://doi.org/10.1056/NEJMoa022273
Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG.(2002). Aortic Pulse-Wave Velocity and its Relationship to Mortality in Diabetes and Glucose Intolerance: an Integrated Index of Vascular Function? Circulation. 106(16):2085-90. https://doi.org/10.1161/01.CIR.0000033824.02722.F7
Darkins A, Ryan P, Kobb R, et al. (2008).Care Coordination/Home Telehealth: Principles, Outcomes, and Lessons Learned. Telemed J E Health. 14(10):1004-20. https://doi.org/10.1089/tmj.2008.0021
DiMatteo MR. (2004).Variations in Patients' Adherence to Medical Recommendations: a Quantitative Review of 50 years of Research. Med Care. ;42(3):200-9. https://doi.org/10.1097/01.mlr.0000114908.90348.f9
Donato AJ, Machin DR, Lesniewski LA. (2015). Mechanisms of Dysfunction in the Aging Vasculature and Role in Age-Related Disease. Circ Res. 116(5):769-79.
Elder K, Osei D, Koffi J, et al. (2020) Reducing Health Disparities Among the Elderly: Community-Based Interventions. Am J Public Health. 110(3):345-52. https://doi.org/10.2105/AJPH.41.3.345-c
Esler M, Lambert E, Schlaich M. (1985). Point: Chronic Activation of the Sympathetic Nervous System is the Dominant Contributor to Systemic Hypertension. J Appl Physiol. 2010 ;109(6):1996-8. https://doi.org/10.1152/japplphysiol.00182.2010
Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJL. (2012) Comparative Risk Assessment Collaborating Group (Cancers). Comparative Quantification of Mortality and Morbidity from Drinking Alcohol: Findings from the Global Burden of Disease Study 2010. Lancet. 2012 ;380(9853) :2224-60.
Ferdinand KC, Nasser SA, Nasser SA. 2020.Antihypertensive Therapy in the Elderly: Current Management and Future Directions. J Clin Hypertens (Greenwich). 22(4):636-50.
Franklin SS, Gustin W 4th, Wong ND, Larson MG, Weber MA, Kannel WB, et al.(1997) Hemodynamic Patterns of Age-Related Changes In Blood Pressure. The Framingham Heart Study. Circulation. 96(1):308-15. https://doi.org/10.1161/01.CIR.96.1.308
Franklin SS, Thijs L, Hansen TW, O'Brien E, Staessen JA. (2013). White-coat Hypertension : New Insights from Recent Studies. Hypertension. 62(6):982-7. https://doi.org/10.1161/HYPERTENSIONAHA.113.01275
Franklin SS. (2007). Hypertension in Older People : part 1. J Clin Hypertens (Greenwich). 9(1) :3-10.
Fryar CD, Ostchega Y, Nwankwo T, et al. (2014). Hypertension Prevalence and Control Among Adults: United States, 2015-2016. NCHS Data Brief. 2017;(289) :1-8.
Gadalean F, Mazzucco S, De Cata G, Manni M, Salvatore F. Effectiveness of Calcium Channel Blockers in Hypertension in Older Adults. Hypertension. 63(6) :1397-405.
Gero A, Radcliff J, Kumar R, et al. (2018). Age-Related Changes in Vascular Function and its Implications for Hypertension Management. J Clin Hypertens (Greenwich). 20(12) :1636-47.
Gnjidic D, Hilmer SN, Blyth FM, et al. (2012). Polypharmacy and Falls in Older People : A Review. J Pharm Pract Res. 42(3) :173-8.
Hansen TW, Thijs L, Boggia J, et al. (2011) Prognostic Value of Home Blood Pressure Measurement in the General Population. Hypertension. 57(3):416-22. https://doi.org/10.1161/HYPERTENSIONAHA.109.133900
He FJ, MacGregor GA. (2010).Reducing Population Salt Intake Worldwide : from Evidence to Implementation. Prog Cardiovasc Dis. 52(5):363-82. https://doi.org/10.1016/j.pcad.2009.12.006
Hermida RC, Crespo JJ, Domínguez-Sardina M, Otero A, Moyá A, Ríos MT, et al.(2018). Bedtime Hypertension Treatment Improves Cardiovascular Risk Reduction : the Hygia Chronotherapy Trial. Eur Heart J. 41(48):4565-76. https://doi.org/10.1093/eurheartj/ehz754
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. (2014) Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 ;311(5):507-20. https://doi.org/10.1001/jama.2013.284427
Jiang H, Liu W, Zhang Y, et al. (2020). Gut Microbiome and Hypertension : A Review of Current Evidence and Future Directions. Hypertension. 76(5) :1425-34.
Joffe SW, Kuo YF, Goodwin JS. (2013). Weight Loss and Hypertension in the Elderly. J Am Geriatr Soc. 61(10) :1875-81.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J.(2005).Global Burden of Hypertension : Analysis of Worldwide Data. Lancet. 365(9455):217-23. https://doi.org/10.1016/S0140-6736(05)17741-1
Kostis JB, Davis BR, Cutler J, Grimm RH Jr, Berge KG, Cohen JD, et al. (1997). Prevention of Isolated Systolic Hypertension in the Elderly (SHEP): Implications for Treatment and Prevention of Cardiovascular Disease. JAMA. 278(22):1757-62. https://doi.org/10.1001/jama.278.3.212
Krousel-Wood MA, Re RN, Weber MA. (2004) Adherence to Antihypertensive Medications: a Systematic Review. J Clin Hypertens (Greenwich). 6(6):285-97.
Krousel-Wood MA, Re RN, Weber MA. (2004).Adherence to Antihypertensive Medications: a Systematic Review. J Clin Hypertens (Greenwich).6(6):285-97.
Kumar S, Das S, Kumar S, et al. (2020). Innovations in Drug Delivery Systems for Hypertension Management : A Review. Expert Opin Drug Deliv.17(6):855-66.
Lakatta EG, Levy D. (2003) Arterial and Cardiac Aging: Major Shareholders in Cardiovascular Disease Enterprises: part I: Aging Arteries: a "set up" for vascular disease. Circulation. 107(1):139-46. https://doi.org/10.1161/01.CIR.0000048892.83521.58
Liu L, Jin X, Xu Y, et al. (2017) Polypharmacy and Drug Interactions in the Elderly: a Review. Expert Rev Clin Pharmacol. 10(7):777-87.
Maddox TM, Rumsfeld JS, Drozda JP, et al. 2019.Digital Health Technologies and Hypertension Management : the Role of Wearable Devices. J Am Coll Cardiol. 74(13) :1686-95.
Mahoney JE, Joffe SW, Kuo YF, Goodwin JS. (2006) Medication Adherence in the Elderly: the Role of Polypharmacy. J Am Geriatr Soc. 54(7):1107-12.
Mahoney JE, Joffe SW, Kuo YF, Goodwin JS. (2014) Polypharmacy and Medication Adherence: Implications for Older Adults. Clin Interv Aging. 9:1885-97.
Mancia G, Fagard R, Narkiewicz K, et al. (2011) ESH/ESC Guidelines for the Management of Arterial Hypertension. Eur Heart J. 2011 ;32(14):2142-209.
Mancia G, Fagard R, Narkiewicz K, et al. (2018) ESC/ESH Guidelines for the Management of Arterial Hypertension. Eur Heart J. 2018 ;39(33):3021-104.https://doi.org/10.1093/eurheartj/ehy339
McManus DD, Hsu P, Fleg JL. (2014). Comprehensive Management of Hypertension in the Elderly: Treatment Strategies. J Am Coll Cardiol.63(11):1164-76.
McManus DD, Riegel B, McCabe P, Roth A, Chan PS, Miller JM, et al.(2020). Contemporary Management of Hypertension in Older Adults. J Am Coll Cardiol. 75(24):2936-48.
McMurray JJ, Packer M, Desai AS, et al.(2014). Angiotensin-Neprilysin Inhibition Versus Enalapril in Heart Failure. N Engl J Med. 371(11):993-1004. https://doi.org/10.1056/NEJMoa1409077
Miller MA, McHale P, Anderson M. (2018). Combination Therapy for Hypertension : Optimal Choices and Dosage. J Cardiovasc Pharmacol Ther. 23(1):50-64.
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. (2015) Heart Disease and Stroke Statistics-2015 Update : a Report from the American Heart Association. Circulation.131(4)
Muller H, Pfitzer J, Kronenberg A, et al.(2018). Adverse Effects of Antihypertensive Drugs in the Elderly: an Overview. Drugs Aging. 35(9):745-56.
Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT Jr, et al.(2018) Potential U.S. Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline. J Am Coll Cardiol. 71(2):109-18. https://doi.org/10.1016/j.jacc.2017.10.073
Muntner P, Shimbo D, Tonelli M, Reynolds K, Arnett DK, Oparil S. (2015). The Relationship Between Visit-to-Visit Variability in Systolic Blood Pressure and All-Cause Mortality in the General Population. Hypertension. 65(2):157-64.
Niiranen TJ, Johansson JK, Reunanen A, Jula AM. (2014). Home-Measured Blood Pressure is a Stronger Predictor of Cardiovascular Risk than Office Blood Pressure : the Finn-Home Study. Hypertension. 64(2):281-6. https://doi.org/10.1161/HYPERTENSIONAHA.114.03292
O'Brien E, Parati G, Stergiou G, Asmar R, Beilin L, Bilo G, et al. (2013). European Society of Hypertension Position Paper on Ambulatory Blood Pressure Monitoring. J Hypertens. 31(9):1731-68.
Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, et al. (2018). Hypertension. Nat Rev Dis Primers. 4(1): 18014. https://doi.org/10.1038/nrdp.2018.14
Parati G, Stergiou GS, Dolan E, Bilo G. Blood Pressure Variability: Clinical Relevance and Application. J Clin Hypertens (Greenwich). 2013 ;15(4):241-54.
Patterson A, Veldhuizen S, MacDonald D, et al. (2015). Stress Reduction Interventions in Hypertension Management : A Systematic Review. J Am Soc Hypertens. 9(6):441-9.
Pescatello LS, Franklin BA, Fagard RH, VanHees L, Bourgeois A, Casirola M, et al. (2015). Exercise and Hypertension : American College of Sports Medicine Position Stand. Med Sci Sports Exerc. 47(5):134-55.
Pickering TG, Gerin W, Schwartz AR. (2002). What is the White-Coat Effect and how Should it be Measured? Blood Press Monit. 7(6):293-300. https://doi.org/10.1097/00126097-200212000-00001
Poulter NR, Prabhakaran D, Caulfield M. Hypertension. Lancet.(2005). 386(9996):801-12. https://doi.org/10.1016/S0140-6736(14)61468-9
Rossi GP, Gherardi G, Dorigatti F, et al. (2017). Target Organ Damage in Hypertension : Mechanisms and Management. J Hypertens. 35(3):499-512.
Sakhuja S, Raeburn C, Kincaid S. (2014).Polypharmacy and Medication Adherence: Implications for Older Adults. Clin Interv Aging. 9:1885-97.
Sarnak MJ, Levey AS, Schoolwerth AC, Coresh J, Culleton B, Hamm LL, et al. (2003).Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: a Statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension. 42(5):1050-65. https://doi.org/10.1161/01.HYP.0000102971.85504.7c
Schmieder RE, Mann JF, Schumacher H, et al. (2007). Aliskiren: A New Treatment Option in Hypertension. J Hypertens. 25(5) :931-8.
Seshiah V, Sahay BK, Das AK, Muruganathan A, Rao PV. (2002). A study on the Prevalence of Dyslipidemia in Elderly Hypertensives and its Relationship with blood pressure. Indian Heart J. 54(4):364-9.
Stergiou GS, Siontis KC, Ioannidis JP.(2010). Home Blood Pressure as a Cardiovascular Outcome Predictor: it's Time to Take this Method Seriously. Hypertension. 55(6):1301-3. https://doi.org/10.1161/HYPERTENSIONAHA.110.150771
Sullivan K, Boucher J, Browne B, et al. (2018). Smart phone Apps and Wearable Devices for Hypertension Management : a Systematic Review. J Hypertens. 36(8):1642-50.
Sullivan ME, Murphy M, Quinn M, et al. (2019). The Role of Precision Medicine in the Management of Hypertension. Hypertension. 73(5):1061-8.
Vaughan L, Fothergill M, Tinker S. (2017). Social Determinants of Health and Health Care Disparities Among Older Adults. J Aging Soc Policy. 29(3):187-207.
Walker KA, Power MC, Gottesman RF. (2017). Defining the Relationship Between Hypertension, Cognitive Decline, and Dementia: a Review. Curr Hypertens Rep. 19(3):24. https://doi.org/10.1007/s11906-017-0724-3
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. (2018) ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018 ;71(19) https://doi.org/10.1016/j.jacc.2017.11.005
Zannad F, McMurray JJV, Krum H, et al. (2000). Eplerenone in Patients with Systolic Heart Failure and Mild Symptoms. N Engl J Med. 343(5) :317-24.
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