Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations
To achieve a consensus on optimal blood pressure (BP) targets for older adults remains challenging, necessitating a trade-off between cardiovascular benefits and the risk of impaired organ perfusion. Evidence suggests that age and frailty have a minimal influence on the cardiovascular benefits of in...
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Elsevier
2025-07-01
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| Series: | Journal of the Formosan Medical Association |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664624004431 |
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| author | Heng-Yu Pan Po-Lung Yang Chun-Hsien Lin Chun-Yi Chi Chia-Wen Lu Tai-Shuan Lai Chih-Fan Yeh Michael Yu-Chih Chen Tzung-Dau Wang Hsien-Li Kao Yen-Hung Lin Mu-Cyun Wang Chih-Cheng Wu |
| author_facet | Heng-Yu Pan Po-Lung Yang Chun-Hsien Lin Chun-Yi Chi Chia-Wen Lu Tai-Shuan Lai Chih-Fan Yeh Michael Yu-Chih Chen Tzung-Dau Wang Hsien-Li Kao Yen-Hung Lin Mu-Cyun Wang Chih-Cheng Wu |
| author_sort | Heng-Yu Pan |
| collection | DOAJ |
| description | To achieve a consensus on optimal blood pressure (BP) targets for older adults remains challenging, necessitating a trade-off between cardiovascular benefits and the risk of impaired organ perfusion. Evidence suggests that age and frailty have a minimal influence on the cardiovascular benefits of intensive BP control in community-dwelling elderly. Nonetheless, an increased incidence of acute kidney injury with intensive BP control has been observed in octogenarians. Therefore, it is recommended to maintain systolic BP below 130 mmHg for hypertensive patients aged 65–80 years. If well-tolerated, a systolic BP target below 120 mmHg can be recommended for patients with chronic kidney disease (CKD). However, no conclusive evidence supports a stringent BP target for patients aged 80 years and older.The selection of antihypertensive medications for elderly patients requires consideration of their cardiovascular condition and potential contraindications. Combination therapy may be necessary to achieve the desired BP target. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the primary choices for patients with CKD. Newer generation mineralocorticoid receptor antagonists may further reduce the risk of cardiovascular or renal events in this population.In conclusion, managing hypertension in elderly patients requires a personalized approach that balances cardiovascular benefits with potential risks, considering individual health profiles and tolerability. |
| format | Article |
| id | doaj-art-be0257abea2c4f1d99fe65dcd0fbdeaf |
| institution | DOAJ |
| issn | 0929-6646 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj-art-be0257abea2c4f1d99fe65dcd0fbdeaf2025-08-20T02:39:56ZengElsevierJournal of the Formosan Medical Association0929-66462025-07-01124S42S4810.1016/j.jfma.2024.09.023Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerationsHeng-Yu Pan0Po-Lung Yang1Chun-Hsien Lin2Chun-Yi Chi3Chia-Wen Lu4Tai-Shuan Lai5Chih-Fan Yeh6Michael Yu-Chih Chen7Tzung-Dau Wang8Hsien-Li Kao9Yen-Hung Lin10Mu-Cyun Wang11Chih-Cheng Wu12Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, TaiwanDepartment of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei City, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei City, TaiwanDivision of Metabolism and Endocrinology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, TaiwanDivision of Nephrology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, TaiwanDepartment of Family Medicine, National Taiwan University Hospital, Taipei City, Taiwan; Corresponding author.Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan; Corresponding author.Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei City, TaiwanDivision of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, TaiwanDivision of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei City, TaiwanDivision of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei City, TaiwanDivision of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei City, TaiwanDepartment of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei City, Taiwan; Corresponding author.Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan; Corresponding author.To achieve a consensus on optimal blood pressure (BP) targets for older adults remains challenging, necessitating a trade-off between cardiovascular benefits and the risk of impaired organ perfusion. Evidence suggests that age and frailty have a minimal influence on the cardiovascular benefits of intensive BP control in community-dwelling elderly. Nonetheless, an increased incidence of acute kidney injury with intensive BP control has been observed in octogenarians. Therefore, it is recommended to maintain systolic BP below 130 mmHg for hypertensive patients aged 65–80 years. If well-tolerated, a systolic BP target below 120 mmHg can be recommended for patients with chronic kidney disease (CKD). However, no conclusive evidence supports a stringent BP target for patients aged 80 years and older.The selection of antihypertensive medications for elderly patients requires consideration of their cardiovascular condition and potential contraindications. Combination therapy may be necessary to achieve the desired BP target. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are the primary choices for patients with CKD. Newer generation mineralocorticoid receptor antagonists may further reduce the risk of cardiovascular or renal events in this population.In conclusion, managing hypertension in elderly patients requires a personalized approach that balances cardiovascular benefits with potential risks, considering individual health profiles and tolerability.http://www.sciencedirect.com/science/article/pii/S0929664624004431AntihypertensiveBlood pressure targetChronic kidney diseaseDiabetesElderly |
| spellingShingle | Heng-Yu Pan Po-Lung Yang Chun-Hsien Lin Chun-Yi Chi Chia-Wen Lu Tai-Shuan Lai Chih-Fan Yeh Michael Yu-Chih Chen Tzung-Dau Wang Hsien-Li Kao Yen-Hung Lin Mu-Cyun Wang Chih-Cheng Wu Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations Journal of the Formosan Medical Association Antihypertensive Blood pressure target Chronic kidney disease Diabetes Elderly |
| title | Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations |
| title_full | Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations |
| title_fullStr | Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations |
| title_full_unstemmed | Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations |
| title_short | Blood pressure targets, medication consideration and special concerns in elderly hypertension part I: General principles and special considerations |
| title_sort | blood pressure targets medication consideration and special concerns in elderly hypertension part i general principles and special considerations |
| topic | Antihypertensive Blood pressure target Chronic kidney disease Diabetes Elderly |
| url | http://www.sciencedirect.com/science/article/pii/S0929664624004431 |
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