Arterial hypertension in older adults: who needs geriatric approach?

Elevated blood pressure (BP) is an important risk factor not only for cardiovascular morbidity and mortality, but also for cognitive decline and loss of autonomy in later life. Randomized clinical trials (RCTs) in populations of older patients living at home with low comorbidity and preserved autonomy showed benefits of decreasing the elevated BP in patients older than 80 years. Older patients with frailty, loss of autonomy and other geriatric problems were systematically excluded from the RCTs. Observational studies in these groups of patients showed an increase in morbidity and mortality at a lower level of BP during antihypertensive therapy. Obviously, in very elderly patients a universal strategy for the BP lowering cannot be applied due to the significant heterogeneity of their functional status. In this review geriatric approach based on assessment of the functional status of the elderly patient, the presence of frailty and degree of loss of autonomy as a basis for decision-making process regarding the antihypertensive therapy is discussed.