Hypertension in Older Frail Adults in an Integrated Care Hub -What is the Guidance for Management in this Cohort?

Abstract Background The current European Society of Hypertension (ESH, 2023) guidelines suggest specific recommendations for very old or frail patients; to maintain an office systolic blood pressure (OSBP) between 140 to 150 mmHg. A reduction of treatment could be considered in these patients with a low OSBP (120 mmHg) or in the presence of severe orthostatic hypotension or a high frailty level. Methods We completed a retrospective chart review of patients 80 years and older, who were referred for frailty and a falls assessment, from November 2021 to April 2024. During the chart review we examined the OSBP recordings for these patients to examine our practice. We explored the medication profile of patients who had an OSBP 120mmHg and 150mmHg. The agents used were ACE inhibitors, Angiotensin Receptor Blockers, Calcium Channel Blockers, Beta Blockers, Diuretics and Alpha Blockers. Results The charts for 52 patients met the criteria and were retrieved for review. The average age was 87 years (range 80-96). 3/52(6%) had a SBP 120mmHg. 27/52(52%) had OSBP between 120 and 149 mmHg. 22/52(42%) had an OSBP 150mmHg. We examined the medication profile of those patients who had an OSBP 120 mmHg. 2/3 patients were on three agents and 1/3 patient was on two agents. Looking at the OSBP profile of those patients who had an OSBP 150mmHg. 6/22(27%) patients were on three agents, 3/22(14%) were on two agents, 12/22(54%) were on one agent and 1/22(5%) were on no antihypertensive treatment. Conclusion From our data we found 6% of our patients were over treated for blood pressure while 42% had uncontrolled OSBP readings. We are conscious of deprescribing in older fallers, but further prescribing may be necessary to achieve published targets as per the ESH guidelines. Further research needs to examine the prevalence of white coat hypertension in our cohort.