The DOI matches its Crossref record; 125 of the 125 references it cites were found in a registry or an index.
Hypertension Management in Older and Frail Older Patients
Open accessAbstract
The prevalence of arterial hypertension, particularly systolic hypertension, is constantly rising worldwide. This is mainly the clinical expression of arterial stiffening as a result of the population’s aging. Chronic elevation in blood pressure represents a major risk factor not only for cardiovascular morbidity and mortality but also for cognitive decline and loss of autonomy later in life. Clinical evidence obtained in community-dwelling older people with few comorbidities and preserved autonomy supports the beneficial effects of lowering blood pressure in older hypertensive subjects even after the age of 80 years. However, observational studies in frail older individuals treated for hypertension have shown higher morbidity and mortality rates compared with those with lower blood pressure levels. Clearly, in very old subjects, the therapeutic strategy of one size fits all cannot be applied because of the enormous functional heterogeneity in these individuals. Geriatric medicine proposes taking into account the function/frailty/autonomy status of older people. In the present review, we propose to adapt the antihypertensive treatment using an easy-to-apply visual numeric scale allowing the identification of 3 different patient profiles according to the functional status and autonomy for activities of daily living. For the preserved function profile, strategies should be those proposed for younger old adults. For the loss of function/preserved activities of daily living’ profile, a more detailed geriatric assessment is needed to define the benefit/risk balance as well as requirements for the tailoring of the various therapeutic strategies. Lastly, for the loss of function and altered activities of daily living’ profile, therapeutic strategies should be thoroughly reassessed, including deprescribing (when considered appropriate). In the near future, controlled trials are necessary for the most frail older subjects (ie, in those systematically excluded from previous clinical trials) to gain stronger evidence regarding the benefits of the various therapeutic strategies.
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Cites
Frailty in Older Adults: Evidence for a Phenotype
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2018 ESC/ESH Guidelines for the management of arterial hypertension
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Cited by
2021 ESC Guidelines on cardiovascular disease prevention in clinical practice
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., Bäck, M., Benetos, A., Biffi, A., Boavida, J.-M., Capodanno, D., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehab484 · Cited by 6,485
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Self-citation2024 ESC Guidelines for the management of elevated blood pressure and hypertension
McEvoy, J. W., McCarthy, C. P., Bruno, R. M., Brouwers, S., Canavan, M. D., Ceconi, C., Christodorescu, R. M., Daskalopoulou, S. S., Ferro, C. J., Gerdts, E., et al. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae178 · Cited by 2,298
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Global Burden of cardiomyopathy and myocarditis in the older adults from 1990 to 2019
Zhang, K., Cheng, X., Qu, N., Song, H., Luo, Y., Ye, T., Xu, Q., Tian, H., Kan, C., & Hou, N. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1018385 · Cited by 12
Metadata
- Authors
- Benetos, A., Petrovic, M., & Strandberg, T.
- Venue
- Circulation Research
- Published
- 2019-03-29
- Volume
- 124
- Issue
- 7
- Pages
- 1045-1060
- ISSN
- 0009-7330 (ISSN-L)
- 1524-4571
- OpenAlex
- W2932248400
- Cited by
- 508
- References
- 125
- FWCI
- 21.20
- Type
- journal article
- Language
- en
- Open access
- bronze
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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
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