A European Survey to Identify Current Practices on the Treatment of Hypertension in Adults >75 Years in Esh Excellence Centres

Objective: Treatment specificities of hypertension in older adults remains a matter of debate. We therefore investigated the clinical practices on the treatment of hypertension in adults >75 years in ESH Excellence Centres (EC). Design and method: A survey with 24 questions was developed by the Working Group Hypertension in Older Adults and addressed to ESH-EC. The survey was questioning therapeutic strategies in treating hypertension in 4 groups of frailty/functionality status: Group 1: Fit, Group 2: Frail and Independent, Group 3: Frail and Dependent Group 4: End of Life. Results: Responses were received from 50 ESH excellence centres. The representatives of these centers who answered (one person per center) were mostly internists (42%), cardiologists (32%) and nephrologists (18%). A total of 48% of respondents stated that they always considered frailty status, whilst a further 48% said that they frequently consider frailty, usually based on general appearance of the patient (68%). The preferable SBP range was considered for the 4 groups. A SBP range of 130-139 mm Hg for Groups 1 and 2 was considered as optimal by 56% of respondents whereas for Group 3, 48% considered a SBP range of 140-149 mmHg and for Group 4, 56% considered SBP 150 mmHg or more as optimal. For Group 1, 46% and 48% of respondents respectively proposed combination therapy in all hypertensives and in grade 2-3 hypertensives. These percentages were respectively 8% and 66% for Group 2, 4%and 34% for Group 3, 2% and 12% for Group 4. When considering a reduction in antihypertensive treatment, 57% did not specify any tool, and 34% used START/STOPP criteria. For Group 1, 42% proposed treatment reduction when SBP was between 100-120 mmHg whereas 40% of the respondents reduced treatment only if SBP <100mmHg. In the 3 other groups about 74-80% proposed to reduce treatment when SBP<120 mmHg. Conclusions: As frailty increases, higher SBP targets are considered optimal; Nevertheless the use of validated tools to improve frailty stratification, is still not standardized.