Arterial Hypertension in Older Adults in the Light of New European Guidelines 2018

Abstract

The tendency of aging of the population and, together with it, the increase in the prevalence of arterial hypertension (HT) determines the need to study the peculiarities of treatment of HT in patients of elderly and senile age. In this regard, in the new Guidelines of the European Society of Cardiology for diagnosis and treatment of HT (2018), the authors identified groups of elderly patients (aged 65-79 years) and very elderly patients (aged ≥80 years), blood pressure (BP) levels for the initiation of antihypertensive therapy and target BP levels, and recommended the main principles of antihypertensive therapy. The new recommendations of the ESH/ESC in 2018 also presented the characteristics of HT management in elderly patients. The necessity of mandatory detection of senile asthenia in elderly patients and determination of the degree of their independence from outside help is emphasized. In all elderly patients, especially in very elderly or fragile patients, it is recommended to evaluate the presence or development of orthostatic hypotension during treatment, as well as actively to detect episodes of hypotension using the 24-hour BP monitoring. For antihypertensive therapy in elderly patients, the same five classes of antihypertensive drugs and their combination are recommended. It is emphasized that if it is not required for the treatment of concomitant diseases, loop diuretics and alpha-blockers should be avoided because their use is associated with an increased risk of falls. It is recommended to investigate the level of serum creatinine more often to evaluate the kidney function and to detect a possible decrease in the glomerular filtration rate because of a decrease in BP and perfusion of the kidneys. The target BP levels indicated in the Guidelines are: systolic BP values 130-139 mm Hg and diastolic BP 70-80 mm Hg. In the Guidelines it is emphasized that elderly patients need careful monitoring of any adverse side effects of antihypertensive drugs.