Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende

Die Highlights vom Kongress des American College of Cardiology 2024

Im April diskutierten die Herz-Kreislauf-Spezialisten aus der ganzen Welt auf dem  Kongress des American College of Cardiology (ACC) u.a. neue Therapieansätze bei akutem Myokardinfarkt, koronarer Herzerkrankung, kardiogenem Schock oder Aortenklappenstenose. In unserem Kongress-Dossier haben wir für Sie Berichte über die „Late-Breaking Trials“ und andere wichtige Studien zusammengestellt. 
Erweiterte Suche
Anmelden
nach oben
Current Hypertension Reports
Erschienen in: Current Hypertension Reports 7/2015

01.07.2015 | Resistant Hypertension (E Pimenta, Section Editor)

Blood Pressure in Older Adults: the Importance of Frailty

verfasst von: Michelle C Odden, Pamela R Beilby, Carmen A Peralta

Erschienen in: Current Hypertension Reports | Ausgabe 7/2015

Einloggen, um Zugang zu erhalten

Abstract

The importance of high blood pressure (BP) and the effect of BP lowering in older adults remain controversial due to the mixed evidence in this population. Frailty status may resolve the apparently conflicting findings and identify subpopulations who share common risk. Emerging evidence demonstrates that low BP is associated with poor outcomes in older frail adults or those with poor functional status. In contrast, in non-frail older adults, low BP appears beneficial. Frail older adults may be at increased risk of hypotension, serious fall injuries, and polypharmacy. Additionally, peripheral BP may not be the best prognostic measure in this population. The majority of clinical practice guidelines give little recommendation for frail older adults, which is likely due to their systematic underrepresentation in randomized controlled trials. Future studies need to consider modifications to safely include frail older adults, and guidelines should consider inclusion of evidence beyond randomized controlled trials.
Literatur
1.
McDonald M, Hertz RP, Unger AN, et al. Prevalence, awareness, and management of hypertension, dyslipidemia, and diabetes among United States adults aged 65 and older. J Gerontol A Biol Sci Med Sci. 2009;64(2):256–63.PubMedCrossRef
2.
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics—2015 update: a report from the American Heart Association. Circulation. 2015;131(4):e29–322.PubMedCrossRef
3.
Goodwin JS. Embracing complexity: a consideration of hypertension in the very old. J Gerontol A Biol Sci Med Sci. 2003;58(7):653–8.PubMedCrossRef
4.
Diehr P, Williamson J, Burke GL, et al. The aging and dying processes and the health of older adults. J Clin Epidemiol. 2002;55(3):269–78.PubMedCrossRef
5.
Mattila K, Haavisto M, Rajala S, et al. Blood pressure and five year survival in the very old. Br Med J (Clin Res Ed). 1988;296(6626):887–9.CrossRef
6.
Poortvliet RK, de Ruijter W, de Craen AJ, et al. Blood pressure trends and mortality: the Leiden 85-plus Study. J Hypertens. 2013;31(1):63–70.PubMedCrossRef
7.
Dorresteijn JA, van der Graaf Y, Spiering W, et al. Relation between blood pressure and vascular events and mortality in patients with manifest vascular disease: J-curve revisited. Hypertension. 2012;59(1):14–21.PubMedCrossRef
8.
Vishram JK, Borglykke A, Andreasen AH, et al. Impact of age on the importance of systolic and diastolic blood pressures for stroke risk: the MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) Project. Hypertension. 2012;60(5):1117–23.PubMedCrossRef
9.
Sabayan B, Oleksik AM, Maier AB, et al. High blood pressure and resilience to physical and cognitive decline in the oldest old: the Leiden 85-plus Study. J Am Geriatr Soc. 2012;60(11):2014–9.PubMed
10.•
Mossello E, Pieraccioli M, Nesti N, et al. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med. 2015;175(4):578–85. In patients with dementia or mild cognitive impairment, the authors found that among those treated with antihypertensives, those with the lowest daytime systolic blood pressure had the greatest decline in cognitive function.PubMedCrossRef
11.
Abreo AP, Glidden D, Painter P, et al. Association of physical function with predialysis blood pressure in patients on hemodialysis. BMC Nephrol. 2014;15:177.PubMedCentralPubMedCrossRef
12.
Lewington S, Clarke R, Qizilbash N, et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903–13.
13.
Rapsomaniki E, Timmis A, George J, et al. Blood pressure and incidence of twelve cardiovascular diseases: lifetime risks, healthy life-years lost, and age-specific associations in 1.25 million people. Lancet. 2014;383(9932):1899–911.
14.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.PubMedCrossRef
15.
Rockwood K, Stadnyk K, MacKnight C, et al. A brief clinical instrument to classify frailty in elderly people. Lancet. 1999;353(9148):205–6.PubMedCrossRef
16.•
Odden MC, Peralta CA, Haan MN, et al. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med. 2012;172(15):1162–8. This was the first study to report a differential association of blood pressure and mortality by frailty status, as measured by performance on a gait test.PubMedCentralPubMedCrossRef
17.
Odden MC, Covinsky KE, Neuhaus JM, et al. The association of blood pressure and mortality differs by self-reported walking speed in older Latinos. J Gerontol A Biol Sci Med Sci. 2012;67(9):977–83.PubMedCentralPubMedCrossRef
18.
Peralta CA, Katz R, Newman AB, et al. Systolic and diastolic blood pressure, incident cardiovascular events, and death in elderly persons: the role of functional limitation in the cardiovascular health study. Hypertension. 2014;64(3):472–80.PubMedCrossRef
19.•
Sabayan B, van Vliet P, de Ruijter W, et al. High blood pressure, physical and cognitive function, and risk of stroke in the oldest old: the Leiden 85-plus Study. Stroke. 2013;44(1):15–20. This study examined both physical and cognitive function as markers of frailty and found higher blood pressure was associated with lower risk of stroke in those with poor function.PubMedCrossRef
20.•
Benetos A, Labat C, Rossignol P, et al. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: the PARTAGE Study. JAMA Intern Med 2015. Published online. This observational study found that in nursing home residents, who are likely to be frail, the combination of multiple medications and lower blood pressure was associated with increased risk of mortality.
21.
Sardar MR, Badri M, Prince CT, et al. Underrepresentation of women, elderly patients, and racial minorities in the randomized trials used for cardiovascular guidelines. JAMA Intern Med. 2014;174(11):1868–70.PubMedCrossRef
22.
Golomb BA, Chan VT, Evans MA, et al. The older the better: are elderly study participants more non-representative? A cross-sectional analysis of clinical trial and observational study samples. BMJ Open. 2012;2(6).
23.
Beckett NS, Peters R, Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887–98.PubMedCrossRef
24.
Odden MC, Peralta CA, Covinsky KE. Walking speed is a useful marker of frailty in older persons—reply. JAMA Intern Med. 2013;173(4):325–6.PubMedCrossRef
25.
Bejan-Angoulvant T, Saadatian-Elahi M, Wright JM, et al. Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials. J Hypertens. 2010;28(7):1366–72.PubMedCrossRef
26.
Ambrosius WT, Sink KM, Foy CG, et al. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials. 2014;11(5):532–46.PubMedCrossRef
27.
Hajjar I. Commentary on Goodwin’s “Embracing complexity: a consideration of hypertension in the very old”. J Gerontol A Biol Sci Med Sci. 2003;58(12):M1146–8.PubMedCrossRef
28.
Newman AB. Commentary on “Embracing complexity: A consideration of hypertension in the very old”. J Gerontol A Biol Sci Med Sci. 2003;58(7):666–7. discussion 669–70.PubMedCrossRef
29.
Michel JP, Grab B, Perrenoud JJ. Commentary on “Embracing complexity: A consideration of hypertension in the very old”. J Gerontol A Biol Sci Med Sci. 2003;58(7):665–6. discussion 669–70.PubMedCrossRef
30.
Lowenthal DT. Commentary on “Embracing complexity: A consideration of hypertension in the very old”. J Gerontol A Biol Sci Med Sci. 2003;58(7):664–5. discussion 669–70.PubMedCrossRef
31.
Hajjar RR. Commentary on “Embracing complexity: A consideration of hypertension in the very old”. J Gerontol A Biol Sci Med Sci. 2003;58(7):661–2. discussion 669–70.PubMedCrossRef
32.
Aronow WS. Commentary on “Embracing complexity: A consideration of hypertension in the very old”. J Gerontol A Biol Sci Med Sci. 2003;58(7):659–60. discussion 669–70.PubMedCrossRef
33.•
Muller M, Smulders YM, de Leeuw PW, et al. Treatment of hypertension in the oldest old: a critical role for frailty? Hypertension. 2014;63(3):433–41. This review article summarizes the pathophysiology of hypertension in the very old and emerging evidence on the role of frailty on treatment.PubMedCrossRef
34.
Benetos A, Gautier S, Labat C, et al. Mortality and cardiovascular events are best predicted by low central/peripheral pulse pressure amplification but not by high blood pressure levels in elderly nursing home subjects: the PARTAGE (Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population) study. J Am Coll Cardiol. 2012;60(16):1503–11.PubMedCrossRef
35.
36.
Rockwood MR, Howlett SE, Rockwood K. Orthostatic hypotension (OH) and mortality in relation to age, blood pressure and frailty. Arch Gerontol Geriatr. 2012;54(3):e255–60.PubMedCrossRef
37.
Klein D, Nagel G, Kleiner A, et al. Blood pressure and falls in community-dwelling people aged 60 years and older in the VHM&PP cohort. BMC Geriatr. 2013;13:50.PubMedCentralPubMedCrossRef
38.•
Tinetti ME, Han L, Lee DS, et al. Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults. JAMA Intern Med. 2014;174(4):588–95. This methodologically sophisticated study found antihypertensive medications were associated with increased fall injuries, especially among those with previous fall injuries.PubMedCentralPubMedCrossRef
39.
Butt DA, Mamdani M, Austin PC, et al. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012;172(22):1739–44.PubMedCrossRef
40.
41.
Fried TR, Tinetti ME, Towle V, et al. Effects of benefits and harms on older persons’ willingness to take medication for primary cardiovascular prevention. Arch Intern Med. 2011;171(10):923–8.PubMedCentralPubMedCrossRef
42.
Charlesworth CJ, Smit E, Lee DS, et al. Polypharmacy among adults aged 65 years and older in the United States: 1988–2010. J Gerontol A Biol Sci Med Sci. 2015.
43.
Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation. 2011;123(21):2434–506.PubMedCrossRef
44.
Gomez-Huelgas R, Giner-Galvan V, Mostaza JM, et al. Unanswered clinical questions in the management of cardiometabolic risk in the elderly: a statement of the Spanish society of internal medicine. BMC Cardiovasc Disord. 2014;14:193.PubMedCentralPubMedCrossRef
45.
James PA, Oparil S, Carter BL, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.PubMedCrossRef
46.
Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.PubMedCrossRef
47.•
Mallery LH, Allen M, Fleming I, et al. Promoting higher blood pressure targets for frail older adults: a consensus guideline from Canada. Cleve Clin J Med. 2014;81(7):427–37. This clinical practice guideline gives recommendation for both the stopping and starting of treatment for high blood pressure in frail older adults.PubMedCrossRef
48.
Institute of Medicine (U.S.). Committee on Standards for Developing Trustworthy Clinical Practice Guidelines., Graham R. Clinical practice guidelines we can trust. Washington, DC: National Academies Press; 2011.
Metadaten
Titel
Blood Pressure in Older Adults: the Importance of Frailty
verfasst von
Michelle C Odden
Pamela R Beilby
Carmen A Peralta
Publikationsdatum
01.07.2015
Verlag
Springer US
Erschienen in
Current Hypertension Reports / Ausgabe 7/2015
Print ISSN: 1522-6417
Elektronische ISSN: 1534-3111
DOI
https://doi.org/10.1007/s11906-015-0564-y

Weitere Artikel der Ausgabe 7/2015

Current Hypertension Reports 7/2015 Zur Ausgabe

Pulmonary Hypertension (J Klinger, Section Editor)

Medical Therapies for the Treatment of Pulmonary Arterial Hypertension: How Do We Choose?

Novel Treatments for Hypertension (T Unger, Section Editor)

Antihypertensive Combination Treatment: State of the Art

Preeclampsia (VD Garovic, Section Editor)

Secondary Hypertension in Pregnancy

Novel Treatments for Hypertension (T Unger, Section Editor)

Benefit of Blood Pressure Control in Diabetic Patients

Therapeutic Trials (M Weir, Section Editor)

Endothelin Receptor Antagonists: New Hope for Renal Protection?

Novel Treatments for Hypertension (T Unger, Section Editor)

New Hypertension Guidelines: Progression or a Step Backwards in Hypertension?

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Mehr Lebenszeit mit Abemaciclib bei fortgeschrittenem Brustkrebs?

24.05.2024 Mammakarzinom Nachrichten

In der MONARCHE-3-Studie lebten Frauen mit fortgeschrittenem Hormonrezeptor-positivem, HER2-negativem Brustkrebs länger, wenn sie zusätzlich zu einem nicht steroidalen Aromatasehemmer mit Abemaciclib behandelt wurden; allerdings verfehlte der numerische Zugewinn die statistische Signifikanz.

ADT zur Radiatio nach Prostatektomie: Wenn, dann wohl länger

24.05.2024 Prostatakarzinom Nachrichten

Welchen Nutzen es trägt, wenn die Strahlentherapie nach radikaler Prostatektomie um eine Androgendeprivation ergänzt wird, hat die RADICALS-HD-Studie untersucht. Nun liegen die Ergebnisse vor. Sie sprechen für länger dauernden Hormonentzug.

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

So sicher sind Tattoos: Neue Daten zur Risikobewertung

22.05.2024 Melanom Nachrichten

Das größte medizinische Problem bei Tattoos bleiben allergische Reaktionen. Melanome werden dadurch offensichtlich nicht gefördert, die Farbpigmente könnten aber andere Tumoren begünstigen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise