Hypertension in older adults: Assessment, management, and challenges

Abstract

Hypertension in older adults is related to adverse cardiovascular outcomes, such as heart failure, stroke, myocardial infarction, and death. The global burden of hypertension is increasing due to an aging population and increasing prevalence of obesity, and is estimated to affect one third of the world's population by 2025. Adverse outcomes in older adults are compounded by mechanical hemodynamic changes, arterial stiffness, neurohormonal and autonomic dysregulation, and declining renal function. This review highlights the current evidence and summarizes recent guidelines on hypertension, pertaining to older adults. Management strategies for hypertension in older adults must consider the degree of frailty, increasingly complex medical comorbidities, and psycho‐social factors, and must therefore be individualized. Non‐pharmacological lifestyle interventions should be encouraged to mitigate the risk of developing hypertension, and as an adjunctive therapy to reduce the need for medications. Pharmacological therapy with diuretics, renin‐angiotensin system blockers, and calcium channel blockers have all shown benefit on cardiovascular outcomes in older patients. Given the economic and public health burden of hypertension in the United States and globally, it is critical to address lifestyle modifications in younger generations to prevent hypertension with age.

Promotion of Healthy Aging Within a Community Center Through Behavior Change: Health and Fitness Findings From the AgeWell Pilot Randomized Controlled Trial

“…Hypertension is thought to increase the risk of developing many chronic conditions common in older adults which include cardiovascular disease, heart failure, stroke, and chronic kidney disease (Oliveros et al, 2020;Pimenta & Oparil, 2012). However, regular exercise can help reduce the risk of developing these conditions in later life by improving blood pressure (Herrod et al, 2018;Oliveros et al, 2020;Wewege, Thom, Rye, & Parmenter, 2018). It must be highlighted again that older adults in the current investigation actually improved their cardiovascular disease risk (QRISK2) despite being one year older.…”

“…As we age our arteries become stiffer, and this increase in arterial stiffness causes an increase in blood pressure. More than two thirds of adults over the age of 65 years are thought to be hypertensive (Oliveros et al, 2020;Pimenta & Oparil, 2012). Hypertension is thought to increase the risk of developing many chronic conditions common in older adults which include cardiovascular disease, heart failure, stroke, and chronic kidney disease (Oliveros et al, 2020;Pimenta & Oparil, 2012).…”

“…More than two thirds of adults over the age of 65 years are thought to be hypertensive (Oliveros et al, 2020;Pimenta & Oparil, 2012). Hypertension is thought to increase the risk of developing many chronic conditions common in older adults which include cardiovascular disease, heart failure, stroke, and chronic kidney disease (Oliveros et al, 2020;Pimenta & Oparil, 2012). However, regular exercise can help reduce the risk of developing these conditions in later life by improving blood pressure (Herrod et al, 2018;Oliveros et al, 2020;Wewege, Thom, Rye, & Parmenter, 2018).…”

The Associations Between Blood Pressure and Quality of Life in Elderly Patients with Hypertension in China

“…There is evidence of increasing prevalence of elder patients with hypertension around the world [1,2].In Mainland China, the prevalence of hypertension in the population over 60 years old is 60.6% and 57.0% in urban and rural areas, respectively [3]. China is a country with a population of 1.4 billion people and the number of elderly patients with hypertension is staggering.…”

“…Treatment of hypertension in the elderly populations quite beneficial in reducing the risk of cardiovascular morbidity and mortality [9][10][11].Available data suggest that lowering of blood pressure in very elderly (aged> 80 years) reduces the risk of heart failure, stroke, and even mortality [12].The review by Suerra C. pointed out that in, it is advisable for elder hypertensive clients to assess their cardiovascular risk situation and quality of life, and to individualize treatment [13].Some studies have paid attention to the relationship between blood pressure and quality of life.For example, Monika et al recruited 3373 hypertensive elderly patients aged over 65 years and the result indicated that the decreased systolic blood pressure (SBP) was associated with the optimal physical scores of quality of life [14]. Furthermore, Kao et al recruited 222 hypertensive subjects aged 20 to 79 years, the results showed the scores of quality of life was increasing with decreasing diastolic blood pressure (DBP) [15].…”