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Review
. 2018 Sep 3:39:26.
doi: 10.1186/s40985-018-0101-z. eCollection 2018.

Screening and treatment of hypertension in older adults: less is more?

Daniela Anker  1 , Brigitte Santos-Eggimann  2 , Valérie Santschi  3 , Cinzia Del Giovane  1 , Christina Wolfson  4 , Sven Streit  1 , Nicolas Rodondi  1   5 , Arnaud Chiolero  1   2   4
Affiliations
Review

Screening and treatment of hypertension in older adults: less is more?

Daniela Anker et al. Public Health Rev. .

Abstract

Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one hand, there is robust evidence that screening and treatment of hypertension prevents CVD and decreases mortality in the middle-aged population. On the other hand, among older adults, observational studies have shown either positive, negative, or no correlation between blood pressure (BP) and cardiovascular outcomes. Furthermore, there is a lack of high quality evidence for a favorable harm-benefit balance of antihypertensive treatment among older adults, especially among the oldest-old (i.e., above the age of 80 years), because very few trials have been conducted in this population. The optimal target BP may be higher among older treated hypertensive patients than among middle-aged. In addition, among frail or multimorbid older individuals, a relatively low BP may be associated with worse outcomes, and antihypertensive treatment may cause more harm than benefit. To guide hypertension screening and treatment recommendations among older patients, additional studies are needed to determine the most efficient screening strategies, to evaluate the effect of lowering BP on CVD risk and on mortality, to determine the optimal target BP, and to better understand the relationship between BP, frailty, multimorbidity, and health outcomes.

Keywords: Frailty; Hypertension; Older adults; Screening.

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Conflict of interest statement

Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Mean SBP and DBP according to age. The data was extracted from the National Health and Nutrition Examination Survey held in the USA between 2013 and 2014. Source: Centers for Disease Control and Prevention [18, 68]
Fig. 2
Fig. 2
Hypertension prevalence according to sex in the USA over the years 2011 to 2014. The data was extracted from the National Health and Nutrition Examination Survey held in the USA between 2011 and 2014. Source: Centers for Disease and Prevention [14]
Fig. 3
Fig. 3
The hypothetical causal relationship between blood pressure (BP) and related adverse health outcomes or mortality according to different scenarios is depicted in these graphs. (I) Usually, BP has a causal effect on adverse health outcomes (O) and death (D). (II) The relationship can be confounded by unmeasured factors (C), which have an effect on both BP and the risk of adverse health outcomes. (III) In a situation of reverse causality, some conditions, which can be initially caused by high BP, evolve to become the cause of low BP
See this image and copyright information in PMC

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