Vnitr Lek 2024, 70(7):419-429 | DOI: 10.36290/vnl.2024.084

Pharmacological treatment of arterial hypertensin in old and very old patient in current evidence-based guidelines

Eva Topinková¹, Jan Filipovský²

¹ Klinika geriatrie a interní medicíny 1. lékařské fakulty Univerzity Karlovy a Všeobecné fakultní nemocnice v Praze

² II. interní klinika Lékařské fakulty Univerzity Karlovy a Fakultní nemocnice Plzeň

Arterial hypertension is one of the most common disorders in older people and there is undoubtedly professional agreement that antihypertensive treatment is beneficial in the wide range of older age for preventing cardiovascular events and reducing overall mortality. However, treatment in old age confers several pharmacological risks. The 2023 Guidelines on hypertension management of the European Society of Hypertension distinguish two age groups (65-79 and 80+years) for which separate criteria for treatment initiation and target blood pressure values are recommended. Unfortunately, there is a gap of evidence on effectiveness and safety of antihypertensives treatment in octogenarians and even less in nonagenarians. Therefore, treatment is based on clinical trials performed in younger populations usually without concomitant comorbidities and functional limitations. In clinical practice treatment decisions in old and very old patients are not exclusively based on EBM recommendations but also on other factors such as comorbidities, physical performance status and self-care, cognitive functioning and life expectancy which warrant individualized pharmacological treatment. The paper reviews current knowledge on changing benefit/risk ratio of antihypertensives in old and frail patients, suggests use of explicit criteria of potentially inappropriate antihypertensives in older persons and provides clinical recommendations for antihypertensives deprescribing but only in strictly eligible patients.

Keywords: arterial hypertension, pharmacological treatment, antihypertensive medication, geriatric pacient, old age 80+ years, evidence-based guidelines, deprescribing antihypertensives.

Accepted: October 24, 2024; Published: November 14, 2024  Show citation