Review Article

Aggressive Hypertension Management in Patients of Advancing and Advanced Age

Authors: Stephanie C. Leeper, MD, FACP

Abstract

Many older patients are not being aggressively managed for hypertension. Healthcare providers are often hesitant to start or even aggressively titrate antihypertensive medication, especially in the aged. Multiple studies have demonstrated that morbidity and mortality can be significantly reduced by appropriate intervention in all age groups. There are some clinical situations, however, where the provider must approach cautiously, such as in patients with a wide pulse pressure or those with a propensity toward adverse reactions. The data are clear that in the United States, undertreatment, rather than overtreatment, appears to be the issue. This article reviews studies that support the aggressive treatment of hypertension. The nuances of aging, which often influence the healthcare provider's treatment decisions, are also discussed. Suggestions for reasonable approaches to these difficult cases will be considered.


Key Points


* The treatment of hypertension reduces the risk of morbidity and mortality, even in those with advancing age.


* Nuances of healthy versus unhealthy aging often modulate the choice of therapy.


* Treatment should be tailored to the aging patient's concomitant diseases.


* Over the past several years, there has been new thought about old drugs that once were considered contraindicated in certain diseases or disorders.


* Healthcare providers should have a thorough understanding of potential adverse reactions that can occur when utilizing antihypertensive therapy.

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