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Review
. 2024 Nov;40(4):629-644.
doi: 10.1016/j.cger.2024.04.004. Epub 2024 May 28.

Pharmacologic Treatment of Hypertension in Older Adults

Oliver M Todd  1 , Matthew Knight  2 , Joshua A Jacobs  3 , Catherine G Derington  4 , James P Sheppard  5 , Adam P Bress  4
Affiliations
Review

Pharmacologic Treatment of Hypertension in Older Adults

Oliver M Todd et al. Clin Geriatr Med. 2024 Nov.

Abstract

The authors conducted a review of pharmacologic therapy in older adults with hypertension. They reviewed the evidence supporting their use in older adults, understanding the physiologic changes and potential adverse drug effects associated with aging and antihypertensive medication use, exploring guideline recommendations for antihypertensive use in older adults, and evaluating the associated risks and benefits of specific classes of antihypertensive medications.

Keywords: Aged pharmacotherapy; Antihypertensive; Blood pressure; Frailty; Hypertension; Multimorbidity.

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Conflict of interest statement

Disclosure The work of Dr O.M. Todd is funded by the UK National Institute for Health and Care Research (NIHR) via an Academic Clinical Lectureship. The work of Dr. M. Knight is funded by the UK NIHR via a Specialized Foundation Programme. The work of Dr. J. Sheppard receives funding from the Wellcome Trust, United Kingdom/Royal Society via a Sir Henry Dale Fellowship (ref: 211182/Z/18/Z), the National Institute for Health and Care Research, United Kingdom (NIHR), and from the British Heart Foundation, United Kingdom (refs: PG/21/10,341; FS/19/13/34,235). The work of Dr. A.P. Bress is supported by R01AG74989, K24AG080168, and R01AG065805 from the National Institute on Aging, United States (Bethesda, MD) and R01HL139837 from the National Heart, Lung, and Blood Institute, United States (Bethesda, MD). This research was funded in part by the Wellcome Trust [211182/Z/18/Z]. For the purpose of open access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission.

Figures

Fig. 1
Fig. 1
Age-based variations in guideline recommendations for initiation of antihypertensive pharmacotherapy based on systolic blood pressure measurements among non-frail, non-institutionalized persons. aAdditional risk factors include target organ damage, established atherosclerotic cardiovascular disease (ASCVD), renal disease, diabetes, estimated 10 year cardiovascular disease risk ≥10%. bHigh-risk conditions include age ≥75 years, clinical or subclinical ASCVD, chronic kidney disease, or 10 year Framingham risk score ≥15%. ACC, American College of Cardiology; ACP, American College of Physicians; AAFP, the American Academy of Family Physicians; ESH, European Society of Hypertension; NICE, the National Institute for Health and Care Excellence; VA/DoD, Veterans Affairs/Department of Defense.
Fig. 2
Fig. 2
BRACE acronym to guide antihypertensive treatment selections for the older adult. ACEI, angiotensin-converting enzyme inhibitor; ADE, adverse drug event; ARB, angiotensin-II receptor blocker; BP, blood pressure; CCB, calcium channel blocker; CVD, cardiovascular disease; TZD, thiazidelike or thiazidetype diuretic.
Fig. 3
Fig. 3
Step-by-step guide to shared decision-making in hypertension management in older adults.
See this image and copyright information in PMC

References

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