hypertension (in the elderly)

Last edited 04/2022 and last reviewed 05/2022

  • hypertension is common in those aged over 60 years (elderly)
  • hypertension in the elderly is associated with an increased risk of coronary heart disease and stroke
  • treatment of elderly hypertension will reduce the risk of a major coronary event by 20% and the incidence of stroke by almost 40%
  • it is important to note that older people show greater BP variability, and thus it is particularly important that multiple measurements are taken on several occasions to confirm the diagnosis of hypertension
    • standing and seated measurements are important during the initial assessment and after initiating drug therapy, because of the high prevalence of orthostatic hypotension
  • in this age group thiazide/thiazide-like diuretics are particularly effective at lowering BP in older people, as are dihydropyridine calcium channel blockers
  • NICE have recommended that (2):
    • for adults with hypertension aged under 80, reduce clinic blood pressure to below 140/90 mmHg and ensure that it is maintained below that level
    • for adults with hypertension aged 80 and over, reduce clinic blood pressure to below 150/90 mmHg and ensure that it is maintained below that level. Use clinical judgement for people with frailty or multimorbidity

Notes:

  • a meta-analysis from the Blood Pressure Lowering Treatment Trialists' Collaboration indicated that reducing blood pressure with antihypertensive drugs reduces CV risk to a similar degree in both younger (<65 years) and older (>65 years) people irrespective of which drug regimen is used (3)
  • HYVET study was a large double-blind, randomised, placebo-controlled trial, which showed that antihypertensive treatment with a thiazide-like diuretic (indapamide) and/or an ACE inhibitor (perindopril) reduced the risk of death from stroke or any cause in patients aged 80 years or older (4)
    • note though that the study sample was a relatively healthy group with low prevalence of diabetes mellitus and coronary artery disease. Patients with heart failure or dermentia and those requiring nursing care were excluded - thus the relative benefits and risks of treating frail elderly people with multiple comorbid conditions were not addressed by this trial (and may never be known) (5)

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