Management of Hypertension in the Elderly and Frail Patient

Abstract

Hypertension is a frequent finding in elderly patients. Hypertension in older age can be both associated with frailty and represent a risk factor for frailty. Hypertension is recognized as a main risk factor for cardiovascular diseases such as heart failure, atrial fibrillation, and stroke and the occurrence of these diseases may provoke a decline in health status and/or worsen the degree of frailty. Blood pressure targets in hypertensive older and frail patients are not completely defined. However, specific evaluations of individual patients and their co-morbidities and assessment of domains and components of frailty, together with weighted consideration of drug use, may help in finding the appropriate therapy.

Fig. 1

The frailty domains and their components

Fig. 2

The frailty trajectory from vulnerable/pre-frail to terminally ill (black arrows). Boxes indicate increasing degrees of frailty that these patients may experience towards end of life. During the trajectory, harmful health events may rapidly increase the degree of frailty. However, this increase can be reverted in some cases, due to appropriate targeting of frailty domains (e.g. introducing rehabilitation or social support)