Hypertension and Frailty Syndrome in Old Age: Current Perspectives

Abstract

Hypertension is considered the most common disorder in the general population. It is both a health and a financial problem worldwide.The Writing Group of the American Society of Hypertension defines hypertension as a cardiovascular syndrome resulting from a number of interconnected factors. 1 Therefore, a comprehensive evaluation is required, involving both the cardiovascular system and other risk factors. In the global population, the prevalence of hypertension is 26.4 %, which is expected to increase to one-third of the population by 2025. 2 The elderly comprise a special group of hypertensive patients because of ageing-related processes. In accordance with data from the Framingham study, 58.9 % of people aged ≥65 and 70 % of those aged ≥80 years are hypertensive. 3 Most patients in the group have isolated systolic hypertension, with normal diastolic blood pressure (DBP) valuesbelow 90 mmHg. In the elderly population, systolic blood pressure (SBP) is a more significant risk factor for cardiovascular complications than DBP. Chronic high SBP leads to left ventricular hypertrophy, as decreased elasticity of large blood vessels -particularly the aortaputs extra strain on the heart. 4 The ageing process involves a number of changes contributing to the development of hypertension. Besides decreased blood vessel elasticity, these include increased collagen content in the extracellular matrix, decreased numbers of elastic fibres, increased vessel wall thickness, and decreased vessel lumen.In the elderly, the lower number of elastic fibres in the vessel wall contributes to increased SBP. AbstractHypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail pa...

How May Coexisting Frailty Influence Adherence to Treatment in Elderly Hypertensive Patients?

“…Without a doubt, treatment of hypertension in older patients poses a significant challenge to treatment teams (polypharmacy, affected pharmacokinetics, atherosclerosis, reduced kidney performance, osteoporosis, and cognitive impairment). Moreover, older hypertensive patients are a special risk group for orthostatic hypertension, polypharmacy, falls, and cognitive impairment [21].…”

“…Identifying the causes of nonadherence to pharmaceutical treatments is a very important factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Precise identification of contributors to low medication adherence is crucial for improving treatment effectiveness and for distinguishing those patients in need of additional supervision in order to decrease the risk of complications from untreated hypertension [21].…”

“…Warwick et al [20] raise some remarks indicating the lack of evidence of an interaction between the effect of treatment for HT and FS as measured by the frailty index (FI). However, it should be emphasised that the management of HT in frail older people is a newly emerging problem [21] and in this context should be undoubtedly considered as a warning sign motivating a preventive actions [22].…”

“…Considering the physiological alterations resulting from ageing and the presence of multiple comorbidities, treatment of hypertension in older patients poses a significant challenge to treatment teams [21]. In clinical practice, special attention should be paid to frail older patients, who should receive tailored treatment.…”

Low Blood ALT Activity and High FRAIL Questionnaire Scores Correlate with Increased Mortality and with Each Other. A Prospective Study in the Internal Medicine Department

“…Regarding the non-elderly, middle-aged population, the terms frailty, sarcopenia and their association with survival in the literature are indeed scarce. Some authors searched for the impact of frailty in sub-populations included in the realm of the general internal medicine: Uchmanowicz and co. investigated the frailty syndrome and its association and impact on arterial hypertension [ 3 ]; Abdel-Kader and co. investigated the frailty following acute kidney injury [ 4 ], Abel and Klepin proposed frailty assessment to replace the patients’ age as a predictor of responses to therapy in various hematologic malignancies [ 5 ]. Nevertheless, none has questioned the value of frailty and sarcopenia assessment within the internal medicine departments themselves.…”