Key result
Screening and treatment of hypertension in older adults lacks clear evidence of benefit for the oldest-old and frail, as observational studies suggest low blood pressure may be associated with increased mortality in these populations.
This review highlights the lack of high-quality evidence for hypertension treatment in the oldest-old and frail populations, suggesting that lower blood pressure targets may cause more harm than benefit in these groups.
Hypertension management in older adults warrants individualized caution; observational data leaves open optimal targets and long-term outcomes.
Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one hand, there is robust evidence that screening and treatment of hypertension prevents CVD and decreases mortality in the middle-aged population. On the other hand, among older adults, observational studies have shown either positive, negative, or no correlation between blood pressure (BP) and cardiovascular outcomes. Furthermore, there is a lack of high quality evidence for a favorable harm-benefit balance of antihypertensive treatment among older adults, especially among the oldest-old (i.e., above the age of 80 years), because very few trials have been conducted in this population. The optimal target BP may be higher among older treated hypertensive patients than among middle-aged. In addition, among frail or multimorbid older individuals, a relatively low BP may be associated with worse outcomes, and antihypertensive treatment may cause more harm than benefit. To guide hypertension screening and treatment recommendations among older patients, additional studies are needed to determine the most efficient screening strategies, to evaluate the effect of lowering BP on CVD risk and on mortality, to determine the optimal target BP, and to better understand the relationship between BP, frailty, multimorbidity, and health outcomes.
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Anker et al. (2018) conducted a review in Hypertension. Screening and treatment of hypertension was evaluated. Screening and treatment of hypertension in older adults lacks clear evidence of benefit for the oldest-old and frail, as observational studies suggest low blood pressure may be associated with increased mortality in these populations.
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