April 25th, 2011
ACC and AHA Publish Expert Consensus Document on Hypertension in the Elderly
Larry Husten, PHD
Although 64% of elderly men and 78% of elderly women have hypertension, this was not considered a significant clinical problem until 2008, when the Hypertension in the Very Elderly Trial (HYVET) trial demonstrated the substantial benefits of reducing blood pressure in these patients. Largely in response to HYVET, the ACC and the AHA have published the first expert consensus document on hypertension in the elderly.
“Treating hypertension in the elderly is particularly challenging because they usually have several health problems and a greater prevalence of cardiovascular risk factors and cardiac events,” said Wilbert Aronow, one of the chairs of the ACC/AHA writing committee, in an ACC press release. “There also needs to be greater vigilance to avoid treatment-related side effects such as electrolyte disturbances, renal dysfunction, and excessive orthostatic blood pressure decline.”
Because so many trials have excluded elderly patients, much of the document relies on expert consensus rather than data from clinical trials. Although the treatment goal for uncomplicated hypertension is defined as <140/90 mm Hg, this goal has not been validated in the elderly population. Additionally, it is unclear whether target systolic blood pressure should be somewhat higher in patients over 80 years of age.
Antihypertensive therapy, according to the document, should be selected based on efficacy, tolerability, specific comorbidities, and cost. Drugs should be started at the lowest dose and increased gradually. The document recommends lifestyle changes for patients, including regular physical activity, salt restriction, weight control, smoking cessation, and avoiding excessive alcohol intake.
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