This brief review discusses pharmacological management of hypertension in very elderly patients, a very powerful and rapidly growing subpopulation of patients.
It is well known that age is the most powerful risk factor for death, cardiovascular death and hypertension. Blood pressure reduction is effective in preventing major vascular events including stroke and heart failure. However, earlier trials were inconclusive as to whether treatment of this age group is beneficial. One of these trials, subgroup meta-analysis (1999) which enrolled 1,670 patients in seven clinical trials, showed a 36% lower risk of stroke and a 39% lower risk of heart failure, but slightly increased all-cause mortality.
More recently, however, data coming from the Hypertension In the Very Elderly Trial (HYVET) has resolved the clinical uncertainty about the relative benefits and risks of antihypertensive treatment in patients over 80 years old. HYVET studied a relatively healthy 3,845 patients, who were assigned to indapamide ± perindopril vs. placebo ± placebo. There was a significant reduction in cardiovascular morbidity and mortality. What was unexpected was that overall mortality reduced as well in actively treated individuals.
No specific guidelines exist for hypertension management for this particular population. Data from clinical trials including HYVET favor thiazide diuretics, angiotensin converting enzyme inhibitors and calcium channel blockers for either mono-therapy or combination therapy for hypertension in the elderly.