Current status and therapeutic considerations of hypertension in the elderly

Abstract

As the prevalence of hypertension in the elderly population is increasing, information regarding the characteristics, optimal blood pressure targets, and special considerations for elderly hypertensive patients is needed to improve clinical outcomes. Various factors should be considered when managing hypertension in elderly patients, and there are many controversial issues and conflicting results related to the optimal treatment of hypertension in the elderly. In this review, we provide an overview of the epidemiology and characteristics of elderly hypertensive patients and discuss the optimal treatment of hypertension in elderly people.

Keywords: Aged; Epidemiology; Hypertension; Therapy.

Figure 1.

The prevalence of hypertension increases gradually with age. Although the prevalence of hypertension has remained relatively constant over the past 20 years, the number of hypertensive patients has steadily increased from 7.6 million in 1998 to 11.7 million in 2016 owing to the rapidly aging Korean population. Data from the 1998 to 2016 Korean National Health and Nutrition Examination Survey are shown. Adapted from Korean Society Hypertension (KSH) et al. [1], according to the Creative Commons License.

Figure 2.

The awareness, treatment, and control rates of hypertension are generally improving. (A) According to data from Korean National Health and Nutrition Examination Survey (KNHANES), the awareness rate among hypertension patients increased from 25% in 1998 to 65% in 2016. (B) The treatment rate also increased from 22% in 1998 to 61% in 2016. (C) During the same period, the control rate increased significantly from 5% to 44% among all patients with hypertension, and (D) from 24% to 71% among treated hypertensive patients, according to KNHANES data. Blue column, male; red column, female. Adapted from Korean Society Hypertension (KSH) et al. [1], according to the Creative Commons License.

Figure 3.

Comorbidities in elderly hypertensives. Patients with multiple comorbidities increased annually in all age groups, and increased more rapidly in elderly hypertensives. CCI, Charlson Comorbidity Index.

Figure 4.

Antihypertensive drug prescriptions among hypertensive patients aged ≥ 65 years. More than 95% of elderly hypertensive patients are treated by either monotherapy or dual combination therapy. (A) Currently, single pill combinations are most often prescribed for the elderly hypertensives to achieve better drug adherence. (B) Calcium channel blocker (CCB) and angiotensin receptor blocker (ARB) are the two most commonly used antihypertensive drugs for elderly hypertensives, followed by beta blocker (BB) and diuretic (DU). (C) Among patients who received dual combination therapy, combined renin-angiotensin system blocker (RASB) and CCB treatment is the most common prescription, followed by combined RASB and DU treatment. ACEI, angiotensin converting enzyme inhibitor.