Arterial Hypertension in Older Adults in the Light of New European Guidelines 2018

• Main Authors: O. D. Ostroumova, A. I. Kochetkov, M. S. Cherniaeva
• Format: Article
• Language: English
• Published: Stolichnaya Izdatelskaya Kompaniya 2018-11-01
• Series: Racionalʹnaâ Farmakoterapiâ v Kardiologii
• Subjects: arterial hypertension; clinical guidelines; antihypertensive therapy; older adult; frailty; cognitive functions
• Online Access: https://www.rpcardio.com/jour/article/view/1768
• ISSN: 1819-6446; 2225-3653

The tendency of aging of the population and,  together with it, the increase in the prevalence of arterial hypertension (HT) determines the need  to study  the  peculiarities of treatment of HT in patients of elderly and  senile age.  In this regard, in the  new  Guidelines of the  European Society of Cardiology for diagnosis and treatment of HT (2018), the authors identified groups  of elderly patients (aged 65-79 years) and very elderly patients (aged ≥80 years), blood pressure (BP) levels for the initiation of antihypertensive therapy and target BP levels, and recommended the main principles of antihypertensive therapy. The new  recommendations of the  ESH/ESC in 2018 also presented the  characteristics of HT management in elderly patients. The necessity of mandatory detection of senile asthenia in elderly patients and  determination of the  degree of their independence from outside help is emphasized. In all elderly patients, especially in very elderly or "fragile" patients, it is recommended to evaluate the  presence or development of orthostatic hypotension during treatment, as well as actively to detect episodes of hypotension using the 24-hour BP monitoring. For antihypertensive therapy in elderly patients, the same five classes of antihypertensive drugs and their combination are recommended. It is emphasized that if it is not required for the treatment of concomitant diseases, loop diuretics and alpha-blockers should be avoided because their use is associated with an increased risk of falls. It is recommended to investigate the level of serum creatinine more often to evaluate the kidney function and to detect a possible decrease in the glomerular filtration rate  because of a decrease in BP and  perfusion of the kidneys. The target BP levels indicated in the Guidelines are: systolic BP values 130-139 mm Hg and diastolic BP 70-80 mm Hg. In the Guidelines it is emphasized that elderly patients need careful monitoring of any adverse  side effects of antihypertensive drugs.