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Presse Med. 2019 Feb;48(2):127-133. doi: 10.1016/j.lpm.2018.11.011. Epub 2019 Jan 18.

[Hypertension in the elderly].

[Article in French]

Author information

1
Hôpital Broca, université Paris Descartes, gériatrie, 54-56, rue Pascal, 75013 Paris, France; AP-HP, hôpital Broca, EA 4468, 75013 Paris, France.
2
Hôpital Broca, université Paris Descartes, gériatrie, 54-56, rue Pascal, 75013 Paris, France; AP-HP, hôpital Broca, EA 4468, 75013 Paris, France. Electronic address: olivier.hanon@aphp.fr.

Abstract

After 80 years old, antihypertensive treatment significantly reduces cardiovascular events. In the elderly, blood pressure target depends on patients' frailty. After 80 years, French guidelines propose to aim a SBP<150 mmHg without orthostatic hypotension and without exceeding the prescription of more than three antihypertensive drugs. The target may be more ambitious for robust elderly patients. The new 2018 European guidelines set: a stricter target for robust elderly patient aged 80 years or older (SBP between 130 and 139 mmHg and DBP between 70 and 79 mmHg); this objective is less strict for frail elderly (with several comorbidities, with loss of autonomy, elderly living in nursing home or with orthostatic hypotension). A recent randomized controlled trial shows a significant reduction in mortality and cardiovascular events by achieving a low blood pressure goal in patients over the age of 75 years old. Five major drug classes can be used: thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and beta-blockers. Beta-blockers are less efficient to prevent stroke and are indicated in second line. However, beta-blockers represent first choice of treatment in cases of heart failure, coronary artery disease or atrial fibrillation. Appropriate follow-up and monitoring enable assessment of safety (recording BP while standing, ionogram, creatinine).

KEYWORDS:

Elderly; Fragilité; Frailty; Hypertension; Hypertension artérielle; Personne âgée

PMID:
30665788
DOI:
10.1016/j.lpm.2018.11.011
[Indexed for MEDLINE]

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