DB-2-3: ANTIHYPERTENSIVE STRATEGIES IN END-OF LIFE OLD PATIENTS (PRO/CON SESSION)

Abstract

High blood pressure (BP) especially systolic BP is very common in older persons and is associated with considerable morbidity and mortality. Evidence from a limited number of clinical studies indicates that people 80+ y.o. can get significant benefits from BP lowering treatments and that targeting SBP < 140 mmHg reduces morbidity and mortality. However, these clinical studies excluded patients with high frailty and severe alteration of functionality/autonomy. Indeed, in subjects with this clinical profiles, observational data indicate that low SBP is associated with higher morbidity and mortality particularly in those with antihypertensive medication and multiple other drug regimens. These observations made in very altered or end-of-life patients by several clinical research groups should be taken into account by the clinicians, and therefore deprescription i.e. reduction of the antihypertensive treatment, should be considered in presence of very low SBP levels (<130mmHg). However, this approach should be viewed with great caution: firstly, observational studies provide weak evidence and therefore further data are needed from controlled clinical trials in very old patients with the health condition and of autonomy status described above, i.e. people who have been systematically excluded from clinical trials so far. Second, deprescribing should be done gradually, taking into account comorbidities and patient preferences. Finally, in these patients, emphasis should be given to the quality of life and symptoms relief when choosing therapeutic strategies. Collaboration between hypertension specialists, geriatricians and clinical pharmacists is a key issue in this perspective.