Hypertension in the elderly: how to treat patients in 2013? The essential recommendations of the Polish guidelines

The prevalence of hypertension is rising with age, and current evidence shows that the majority of elderly patients benefit from proper antihypertensive therapy. To support physicians in everyday care of elderly patients with hypertension, new guidelines were issued in Poland at the end of 2012. In 2013, the guidelines started to be implemented into practice. The aim of this article is to present an overview of the major recommendations included in these 2013 guidelines. Physicians should be aware of the key issues specific for the care of the elderly hypertensive population. Lowering blood pressure below 150/90 mmHg should be considered as the goal of therapy in hypertensive patients older than 80 years. Slight overweight (body mass index, 27-28 kg/m2) may be beneficial for patients older than 75 years and especially for octogenarians because it may prevent protein and calorie deficiency. Thiazide-like diuretics followed by angiotensin-converting-enzyme inhibitors, if needed, should be considered as a first-line therapy for hypertensive patients older than 80 years. Because of high risk of adverse effects, the pharmacological treatment of hypertension in the elderly should be started with lower doses of blood pressure-lowering agents, and treatment intensification should be careful. The guidelines on hypertension management were developed by 3 medical societies and specialists from different medical fields. The Delphi method was used to achieve consensus on controversial issues.