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Drugs & Aging

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01.05.2014 | Current Opinion

Treatment of Hypertension in Older Persons: What Is the Evidence?

verfasst von: John E. Morley

Erschienen in: Drugs & Aging | Ausgabe 5/2014

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Abstract

Evidence for treatment of hypertension in older people is limited to placebo-controlled studies that reduced blood pressure in persons over 60 years who had systolic blood pressure >160 mmHg. Generally, physicians measure blood pressure poorly, failing to look for white coat or masked hypertension, orthostasis, postprandial hypotension, or pseudohypertension. There is evidence that if 24-hour ambulatory blood pressures were obtained, the treatment goal should be substantially lower. Sleep apnea, pain, nocturnal hypoglycemia, drugs, excess aldosterone production, and pheochromocytoma should all be considered as causes of hypertension in older persons. Evidence supports a low-dose diuretic or an angiotensin converting enzyme inhibitor as appropriate first-line therapies in older persons.

Cheung BM, Ong KL, Mann YB, et al. Prevalence, awareness, treatment, and control of hypertension: United States National Health and Nutrition Examination Survey 2001–2002. J Clin Hypertens (Greenwich). 2006;8:93–8.

Ostchega Y, Dillon CF, Hughes JP, et al. Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: Data from the National Health and Nutrition Examination Survey, 1998 to 2004. J Am Geriatr Soc. 2007;55:1056–65.PubMed

Burt VL, Shelton P, Roccella EJ, et al. Prevalence of hypertension in the US adult population: results from the Third National health and Nutritional Examination Survey, 1988–1991. Hypertension. 1995;25:305–13.PubMed

Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303:2043–50.PubMed

Moser M. From JNC, 1 to JNC 7—what have we learned? Prog Cardiovasc Dis. 2006;48:303–15.PubMed

Materson BJ. JNC8 transmogrified. J Clin Hypertens (Greenwich). 2013;15:704. doi:10.111/jch.12174.

James PA, Opanl 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 (JNC8). JAMA. 2014;311:507–20.PubMed

Mallery LH, Ransom T, Steeves B, et al. Evidence-informed guidelines for treating frail older adults with type 2 diabetes: From the diabetes care program of Nova Scotia (DCPNS) and the palliative and therapeutic harmonization (PATH) program. J Am Med Dir Assoc. 2013;14:801–8.PubMed

Morley JE, Vellas B, van Kan GA, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14:392–7.PubMed

10.

von Haehling S, Anker SD, Doehner W, et al. Frailty and heart disease. Int J Cardiol. 2013;168:1745–7.

11.

Musini VM, Tejani AM, Bassett K, Wright JM. Pharmacotherapy for hypertension in the elderly. Cochrane Database Syst Rev. 2009;(4):CD000028. doi:10.1002/14651858.CD000028.pub2.

12.

McGuiness B, Todd S, Passmore P, Bullock R. Blood pressure lowering in patients without prior cerebrovascular disease for prevention of cognitive impairment and dementia. Cochrane Database Syst Rev. 2009;(4):CD004034. doi:10.1002/14651858.CD004034.pub3.

13.

Peters R, Beckett N, Forette F, HYVET investigators, et al. Incident dementia and blood pressure lowering in the hypertension in the very elderly trial cognitive function assessment (HYVET-COG): A double-blind, placebo controlled trial. Lancet Neurol. 2008;7:683–9.PubMed

14.

Morley JE. Mild cognitive impairment—a treatable condition. J Am Med Dir Assoc. 2014;15:1–5.PubMed

15.

Schall P, Wehling M. Treatment of arterial hypertension in the very elderly: a meta-analysis of clinical trials. Arzneimittelforschung. 2011;61:221–8.PubMed

16.

Morley JE. Hypertension: is it overtreated in the elderly. J Am Med Dir Assoc. 2010;11:147–52.PubMed

17.

Mattila K, Haavisto M, Rajala S, Heikinheimo R. Blood pressure and five year survival in the very old. Br Med J Clin Res Ed. 1988;296:887–9.PubMedCentralPubMed

18.

Sorensen KH, Hilden T. Increased total mortality and decreased functional capacity are associated with low systolic blood pressure among elderly women. Scand J Prim Health Care. 1988;6:105–10.PubMed

19.

Beckett NS, Peters R, Fletcher AE, HYVET Study Group, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887–98.PubMed

20.

Bulpitt CJ, Beckett N, Peters R, et al. Does white coat hypertension require treatment over age 80? Results of the hypertension in the very elderly trial ambulatory blood pressure side project. Hypertension. 2013;61:89–94.PubMed

21.

Peters R, Beckett N, Burch L, et al. The effect of treatment based on a diuretic (indapamide) +/− ACE inhibitor (perindopril) on fractures in the hypertension in the very elderly trial (HYVET). Age Ageing. 2010;39:609–16.PubMed

22.

Butt DA, Mamdani M, Austin PC, et al. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012;172:1739–44.PubMed

23.

Berry SD, Zhu Y, Choi H, et al. Diuretic initiation and the acute risk of hip fracture. Osteoporos Int. 2013;24:689–95.PubMedCentralPubMed

24.

Morley JE. Frailty, falls and fractures. J Am Med Dir Assoc. 2013;14:149–51.PubMed

25.

Lalande A, Roux C, Graulet AM, et al. The diuretic indapamide increases bone mass and decreases bone resorption in spontaneously hypertensive rats supplemented with sodium. J Bone Miner Res. 1998;13:1444–50.PubMed

26.

Giusti A, Barone A, Pioli G, et al. Alendronate and indapamide alone or in combination in the management of hypercalciuria associated with osteoporosis: a randomized controlled trial of two drugs and three treatments. Nephrol Dial Transplant. 2009;24:1472–7.PubMed

27.

Morley JE. Developing novel therapeutic approaches to frailty. Curr Pharm Des. 2009;15(29):3384–95.PubMed

28.

Yamada M, Nishiguchi S, Fukutani N, et al. Prevalence of sarcopenia in community-dwelling Japanese older adults. J Am Med Dir Assoc. 2013. pii: S1525-8610(13)00504-5 (Epub ahead of print).

29.

Malmstrom TK, Morley JE. SARC-F: a simple questionnaire to rapidly diagnose sarcopenia. J Am Med Dir Assoc. 2013;14:531–2.PubMed

30.

Roman D, Mahoney K, Mohamadi A. Sarcopenia: what’s in a name? J Am Med Dir Assoc. 2013;14:80–2.PubMed

31.

Morley JE, Abbatecola AM, Argiles JM, Society on Sarcopenia, Cachexia and Wasting Disorders Trialist Workshop, et al. Sarcopenia with limited mobility: an international consensus. J Am Med Dir Assoc. 2011;12:403–9.PubMed

32.

Sumukadas D, Witham MD, Struthers AD, McMurdo ME. Effect of perindopril on physical function in elderly people with functional impairment: a randomized controlled trial. CMAJ. 2007;177:867–74.PubMedCentralPubMed

33.

Hutcheon SD, Gillespie ND, Crombie IK, et al. Perindopril improves six minute walking distance in older patients with left ventricular systolic dysfunction: a randomized double blind placebo controlled trial. Heart. 2002;88:373–7.PubMedCentralPubMed

34.

Sumukadas D, Band M, Miller S, et al. Do ACE inhibitors improve the response to exercise training in functionally impaired older adults? A randomized controlled trial. J Gerontol A Biol Sci Med Sci. 2013 (Epub ahead of print).

35.

Duboc D, Meune C, Pierre B, et al. Perindopril preventive treatment on mortality in Duchenne muscular dystrophy: 10 years’ follow-up. Am Heart J. 2007;154:596–602.PubMed

36.

Franklin SS, Thijs L, Hansen TW, International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators, et al. Significance of white-coat hypertension in older persons with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population. Hypertension. 2012;59:564–71.PubMedCentralPubMed

37.

Anzal M, Palmer AJ, Starr J, Bulpitt CJ. The prevalence of pseudohypertension in the elderly. J Hum Hypertens. 1996;10:409–11.PubMed

38.

Zuschke CA, Pettyjohn FS. Pseudohypertension. South Med J. 1995;88:1185–90.PubMed

39.

Iwanczyk L, Weintraub NT, Rubenstein LZ. Orthostatic hypotension in the nursing home setting. J Am Med Dir Assoc. 2006;7:163–7.PubMed

40.

Luukinen H, Koski K, Laippala P, Kivela SL. Prognosis of diastolic and systolic orthostatic hypotension in older persons. Arch Intern Med. 1999;159:273–80.PubMed

41.

Beckett NS, Connor M, Sadler JD, et al. Orthostatic fall in blood pressure in the very elderly hypertensive: results from the hypertension in the very elderly trial (HYVET)—pilot. J Hum Hypertens. 1999;13:839–40.PubMed

42.

Morley JE. Is low blood pressure dangerous? J Am Geriatr Soc. 1991;39:1239–40.PubMed

43.

Deegan BM, O’Connor M, Lyons D, O’Laighin G. Development and evaluation of new blood pressure and heart rate signal analysis techniques to assess orthostatic hypotension and its subtypes. Physiol Meas. 2007;28:N87–102.PubMed

44.

Vu MQ, Weintraub N, Rubenstein LZ. Falls in the nursing home: Are they preventable? J Am Med Dir Assoc 2006;7(3 Suppl):S53–S58, 52.

45.

Morley JE. Falls—where do we stand? Mol Med. 2007;104:63–7.

46.

Jansen RW, Kelly-Gagnon MM, Lipsitz LA. Intraindividual reproducibility of postprandial and orthostatic blood pressure changes in older nursing-home patients: relationship with chronic use of cardiovascular medications. J Am Geriatr Soc. 1996;44:383–9.PubMed

47.

Jansen RW, Lipsitz LA. Postprandial hypotension: epidemiology, pathophysiology, and clinical management. Ann Intern Med. 1995;122:286–95.PubMed

48.

Morley JE. Postprandial hypotension—the ultimate Big Mac attack. J Gerontol A Biol Sci Med Sci. 2001;56:M741–3.PubMed

49.

Edwards BJ, Perry HM 3rd, Kaiser FE, et al. Relationship of age and calcitonin gene-related peptide to postprandial hypotension. Mech Ageing Dev. 1996;87:61–73.PubMed

50.

Jian ZJ, Zhou BY. Efficacy and safety of acarbose in the treatment of elderly patients with postprandial hypotension. Chin Med J (Engl). 2008;121:2054–9.

51.

Lee A, Patrick P, Wishart J, et al. The effects of miglitol on glucagon-like peptide-1 secretion and appetite sensations in obese type 2 diabetics. Diabetes Obes Metab. 2002;4:329–35.PubMed

52.

Franklin SS. Elderly hypertensives: how are they different? J Clin Hypertens. 2012;14:779–86.

53.

Franklin SS, Thijs L, Hansen TW, et al. Significance of white-coat hypertension in older person with isolated systolic hypertension: a meta-analysis using the International Database on Ambulatory Blood Pressure Monitoring in Relation to Cardiovascular Outcomes population. Hypertension. 2012;59:565–71.

54.

Franklin SS, Khan SA, Wong ND, et al. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation. 1999;100:354–60.PubMed

55.

Protogerou AD, Safar ME, Iaria P, et al. Diastolic blood pressure and mortality in the elderly with cardiovascular disease. Hypertension. 2007;50:172–80.PubMed

56.

Franklin SS, Chow VH, Mori AD, Wong ND. The significance of low DBP in US adults with isolated systolic hypertension. J Hypertens. 2011;29:1101–8.PubMed

57.

Gonzaga CC, Calhoun DA. Resistant hypertension and hyperaldosteronism. Curr Hypertens Rep. 2008;10:496–503.PubMed

58.

Mulatero P, Bertello C, Verhovez A, et al. Differential diagnosis of primary aldosteronism subtypes. Curr Hypertens Rep. 2009;11:217–23.PubMed

59.

Azizan EA, Poulsen H, Tuluc P, et al. Somatic mutations in ATP1A1 and CACNA1D underlie a common subtype of adrenal hypertension. Nat Genet. 2013;45:1055–60.PubMed

60.

Veldhuis JD, Sharma A, Roelfsema F. Age-dependent and gender-dependent regulation of hypothalamic–adrenocorticotropic–adrenal axis. Endocrinol Metab Clin North Am. 2013;42:201–25.PubMed

61.

Kopetschke R, Slisko M, Kilisli A, et al. Frequent incidental discovery of phaeochromocytoma: data from a German cohort of 201 phaeochromocytoma. Eur J Endocrinol. 2009;161:355–61.PubMed

62.

Dominguez LJ, Bevilacqua M, Dibella G, Barbagallo M. Diagnosing and managing thyroid disease in the nursing home. J Am Med Dir Assoc. 2008;9:9–17.PubMed

63.

Yokokawa K, Tahara H, Kohno M, et al. Hypertension associated with endothelin-secreting malignant hemangioendothelioma. Ann Intern Med. 1991;114:213–5.PubMed

64.

Das AM, Khayat R. Hypertension in obstructive sleep apnea: risk and therapy. Expert Rev Cardiovasc Ther. 2009;7:619–26.PubMed

65.

Onen SH, Lesourd B, Ouchchane L, et al. Occult nighttime hypertension in daytime normotensive older patients with obstructive sleep apnea. J Am Med Dir Assoc. 2012;13:752–6.PubMed

66.

Resnick HE, Phillips B. Documentation of sleep apnea in nursing homes: United States 2004. J Am Med Dir Assoc. 2008;9:260–4.PubMed

67.

Haus DC, Foster GL, Nielo FJ, et al. Age-dependent associations between sleep-disordered breathing and hypertension: importance of discriminating between systolic/diastolic hypertension and isolated systolic hypertension in the Sleep Heart Health Study. Circulation. 2005;111:614–21.

68.

Lukas A, Mayer B, Fialová D, et al. Pain characteristics and pain control in European nursing homes: cross-sectional and longitudinal results from the Services and Health for Elderly in Long TERm care (SHELTER) study. J Am Med Dir Assoc. 2013;14:421–8.PubMed

69.

Chester JG, Rudolph JL. Vital signs in older patients: age-related changes. J Am Med Dir Assoc. 2011;12:337–43.PubMedCentralPubMed

70.

Sinclair A, Morley JE. How to manage diabetes mellitus in older persons in the 21^st century: applying these principles to long term diabetes care. J Am Med Dir Assoc. 2013;14:777–80.PubMed

71.

Morley JE. Depression in nursing home residents. J Am Med Dir Assoc. 2010;11:301–3.PubMed

72.

Pilz S, Tomaschitz A, Ritz E, Pieber TR. Medscape. Vitamin D status and arterial hypertension: a systematic review. Nat Rev Cardiol. 2009;6:621–30.PubMed

73.

Morley JE. Anorexia of aging: a true geriatric syndrome. J Nutr Health Aging. 2012;16:422–5.PubMed

74.

Soenen S, Chapman IM. Body weight, anorexia, and undernutrition in older people. J Am Med Dir Assoc. 2013;14:642–8.PubMed

75.

Morley JE. Weight loss in older persons: new therapeutic approaches. Curr Pharm Des. 2007;13:3637–47.PubMed

76.

Morley JE. Pathophysiology of the anorexia of aging. Curr Opin Clin Nutr Metab Care. 2013;16:27–32.PubMed

77.

Bibbins-Domingo K. The Institute of Medicine Report sodium intake in populations: assessment of evidence: summary of primary findings and implications for clinicians. JAMA Intern Med. 2014;174:136–7. doi:10.1001/jamainternmed.2013.11818.PubMed

78.

Aliti GB, Rabelo ER, Clausell N, et al. Aggressive fluid and sodium restriction in acute decompensated heart failure: a randomized clinical trial. JAMA Intern Med. 2013;173:1058–64.PubMed

79.

Mitka M. IOM report: evidence fails to support guidelines for dietary salt reduction. JAMA. 2013;309:2535–6.PubMed

80.

O’Donnell MJ, Yusuf S, Mente A, et al. Urinary sodium potassium excretion and risk of cardiovascular events. JAMA. 2011;306:2229–38.PubMed

81.

Stolarz-Skrzypek K, Liu Y, Thijs L, et al. Blood pressure, cardiovascular outcomes and sodium intake, a critical review of the evidence. Acta Clin Belg. 2012;67:403–10.PubMed

82.

Cohen HW, Hailpern SM, Fang J, Alderman MH. Sodium intake and mortality in the NHANES II follow-up study. Am J Med. 2006;119:275.e7–14.PubMed

83.

Wright JT Jr, Dunn JK, Cutler JA, et al. Outcomes in hypertensive black and nonblack patients treated with chlorthalidone, amlodipine, and lisinopril. JAMA. 2005;293:1595–608.PubMed

84.

Gunathilake R, Oldmeadow C, McEvoy M, et al. Mild hyponatremia is associated with impaired cognition and falls in community-dwelling older persons. J Am Geriatr Soc. 2013;61:1838–9.PubMed

85.

Miller M, Morley JE, Rubenstein LZ. Hyponatremia in a nursing home population. J Am Geriatr Soc. 1995;43:1410–3.PubMed

86.

Thomas DR, Cote TR, Lawhorne L, Dehydration Council, et al. Understanding clinical dehydration and its treatment. J Am Med Dir Assoc. 2008;9:292–301.PubMed

87.

Silver AJ, Morley JE. Role of the opioid system in the hypodipsia associated with aging. J Am Geriatr Soc. 1992;40:556–60.PubMed

88.

Moser M, Feig PU. Fifty years of thiazide diuretic therapy for hypertension. Arch Intern Med. 2009;169:1851–6.PubMed

89.

Yusuf S, Teo KK, Pogue J, ONTARGET Investigators, et al. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008;358:1547–59.PubMed

90.

Fried LF, Emanuele N, Zhang JH, et al. Combined angiotensin inhibition for the treatment of diabetic nephropathy. N Engl J Med. 2013;369:1892–903.PubMed

91.

Anonymous. Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ. 1992;304:405–12.

92.

Fraser HS. Reserpine: a tragic victim of myths, marketing, and fashionable prescribing. Clin Pharmacol Ther. 1996;60:368–73.PubMed

93.

Griebenow R, Pittrow DB, Weidinger G, et al. Low-dose reserpine/thiazide combination in first-line treatment of hypertension: efficacy and safety compared to an ACE inhibitor. Blood Press. 1997;6:299–306.PubMed

94.

Krönig B, Pittrow DB, Kirch W, et al. Different concepts in first-line treatment of essential hypertension. Comparison of a low-dose reserpine-thiazide combination with nitrendipine monotherapy. German Reserpine in Hypertension Study Group. Hypertension. 1997;29:651–8.PubMed

95.

Messerli FH. Vasodilatory edema: a common side effect of antihypertensive therapy. Curr Cardiol Rep. 2002;4:479–82.PubMed

96.

JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res. 2008;31:2115–27.

97.

Rakugi H, Ogihara T, Goto Y, Ishii M, JATOS Study Group. Comparison of strict- and mild-blood pressure control in elderly hypertensive patients: a per-protocol analysis of JATOS. Hypertens Res. 2010;33:1124–8.PubMed

98.

Supiano MA. Healthy people aged 80 and older with systolic blood pressure greater than 150 mmHg should be treated. J Am Geriatr Soc. 2013;61:1199–200.PubMed

99.

Tolson D, Rolland Y, Andrieu S, et al. International Association of Gerontology and Geriatrics: a global agenda for clinical research and quality of care in nursing homes. J Am Med Dir Assoc. 2011;12:184–9.PubMed

100.

Lopez D, Flicker L, Dobson A. Validation of the frail scale in a cohort of older Australian women. J Am Geriatr Soc. 2012;60:171–3.PubMed

101.

Hyde Z, Flicker L, Almeida OP, et al. Low free testosterone predicts frailty in older men: the health in men study. J Clin Endocrinol Metab. 2010;95:3165–72.PubMed

102.

Woo J, Leung J, Morley JE. Comparison of frailty indicators based on clinical phenotype and the multiple deficit approach in predicting mortality and physical limitation. J Am Geriatr Soc. 2012;60:1478–86.PubMed

103.

Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16:601–8.PubMed

104.

Ravindrarajah R, Lee DM, Pye SR, et al. The ability of three different models of frailty to predict all-cause mortality: results from the European Male Aging Study (EMAS). Arch Gerontol Geriatr. 2013;57:360–8.PubMed

105.

Welsh T, Gladman J, Gordon AL. The treatment of hypertension in care home residents: a systematic review of observational studies. J Am Med Dir Assoc. 2014;15:8–16.PubMed

106.

Aronow WS. Treatment of hypertension in the elderly. J Am Med Dir Assoc. 2013;14:847.PubMed

107.

Koka M, Joseph J, Aronow WS. Adequacy of control of hypertension in an academic nursing home. J Am Med Dir Assoc. 2007;8:538–40.PubMed

108.

Mossello E, Pieraccioli MC, Zanieri S, et al. Ambulatory blood pressure monitoring in older nursing home residents: diagnostic and prognostic role. J Am Med Dir Assoc. 2012;13:760.e1–5.PubMed

Titel: Treatment of Hypertension in Older Persons: What Is the Evidence?
verfasst von: John E. Morley
Publikationsdatum: 01.05.2014
Verlag: Springer International Publishing
Erschienen in: Drugs & Aging / Ausgabe 5/2014
Print ISSN: 1170-229X
Elektronische ISSN: 1179-1969
DOI: https://doi.org/10.1007/s40266-014-0171-7

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