Evaluation and Management of Hypertension in Older Adults

Increasing awareness on frailty in the management of hypertensive older adults.

OBJECTIVE: To provide an up-to-date review of current hypertension (HTN) guidelines and discuss pharmacotherapeutic management of HTN in the older adult population.<br/> DATA SOURCES: A PubMed search of articles published through June 2018 was performed using a combination of the following words: elderly, older adults, geriatric, and HTN.<br/> STUDY SELECTION/DATA EXTRACTION: Relevant original research, review articles, and guidelines were assessed for the management of HTN in older adults. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, complete results, and after a thorough discussion among the authors.<br/> DATA SYNTHESIS: HTN is a common chronic disease state in older adults. Until recently, most guidelines recommended a higher threshold for blood pressure targets in this population, compared with the general adult population. In 2017, two new guidelines for the management of HTN were published, which provided conflicting recommendations for blood pressure goals in the older population. This article reviews current U. S. HTN guidelines published in 2014 to 2017 that most commonly influence patient care, and it specifically addresses the blood pressure targets and pharmacotherapeutic management of HTN in older adults.<br/> CONCLUSION: Management of HTN in older adults is important to avoid further complications and improve outcomes in this population. Blood pressure targets and HTN management should be individualized in older adults based on comorbid conditions, life expectancy, and risk for adverse drug events.

OBJECTIVE: To provide an up-to-date review of current hypertension (HTN) guidelines and discuss pharmacotherapeutic management of HTN in the older adult population.<br/> DATA SOURCES: A PubMed search of articles published through June 2018 was performed using a combination of the following words: elderly, older adults, geriatric, and HTN.<br/> STUDY SELECTION/DATA EXTRACTION: Relevant original research, review articles, and guidelines were assessed for the management of HTN in older adults. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, complete results, and after a thorough discussion among the authors.<br/> DATA SYNTHESIS: HTN is a common chronic disease state in older adults. Until recently, most guidelines recommended a higher threshold for blood pressure targets in this population, compared with the general adult population. In 2017, two new guidelines for the management of HTN were published, which provided conflicting recommendations for blood pressure goals in the older population. This article reviews current U. S. HTN guidelines published in 2014 to 2017 that most commonly influence patient care, and it specifically addresses the blood pressure targets and pharmacotherapeutic management of HTN in older adults.<br/> CONCLUSION: Management of HTN in older adults is important to avoid further complications and improve outcomes in this population. Blood pressure targets and HTN management should be individualized in older adults based on comorbid conditions, life expectancy, and risk for adverse drug events.

OBJECTIVE: To critically analyze the scientific evidence regarding the importance and impacts of interprofessional practices and integrated care strategies in the management of systemic arterial hypertension in older adults within the context of Primary Health Care. METHODOLOGY: Literature review conducted between January and May 2025, with searches in PubMed, Medline, and Cochrane Library databases. Studies published in the last five years addressing interprofessional practices and integrated care in the management of hypertension in older adults in Primary Health Care were selected. Selection followed the criteria proposed by Galvão, Pansani, and Harrad, and the Joanna Briggs Institute, using the PICO strategy to define the research question. RESULTS AND DISCUSSION: Nine studies were included, demonstrating that interprofessional care in Primary Health Care improves blood pressure control, increases treatment adherence, and promotes quality of life in hypertensive older adults. Collaborative work among health professionals enables integrated and individualized interventions, favoring the clinical and psychosocial management of hypertension. The use of digital technologies and home follow-up strengthen the therapeutic bond and expand access to care. Despite the benefits, challenges such as inadequate training and resistance to collaborative models still limit the full implementation of these practices. CONCLUSION: Interprofessional practices and integrated care in Primary Health Care have significant positive impacts on the management of hypertension in older adults, promoting better clinical control, quality of life, and rationalization of health resources. Strengthening these approaches through professional training, effective communication, use of technologies, and patient-centered strategies is recommended to ensure comprehensive and humanized care.

Hypertension is an important factor affecting the health of older adults. Antihypertensives can reduce stroke, cardiovascular events, and mortality in older hypertensive patients. Blood pressure management is difficult in older adults since geriatric syndromes such as frailty and comorbidities often coexist with hypertension. Recent guidelines propose taking functional status into account when targeting blood pressure in older people. Therefore, a better understanding and control of frailty risk factors could improve the prognosis of older adults with hypertension. However, there are relatively few studies on hypertension and frailty in older adults, especially studies focused on antihypertensive treatment. The goals, target values, and choice of antihypertensive treatment for frail older adults are still disputed. We reviewed the recent literature focusing on frailty and hypertension in older adults and propose a management process for screening and assessing frailty and hypertension before the use of antihypertensives. The process can support older adults with lifestyle interventions and frailty management and help them begin taking a single antihypertensive medication.

Resistant Hypertension: Diagnosis and Management.

Management of Hypertension in the Older Adult Hospitalized With Community-Acquired Pneumonia

A Compendium on Hypertension: New Advances and Future Impact.

Arterial hypertension is a major risk factor for cardiovascular morbidity and mortality, and highly prevalent in older age, underscoring the importance of its appropriate management. The population is ageing at an increasing rate, with those aged 80+ years being the fastest growing population characterized by high heterogeneity in terms of functionality and autonomy. The prevalence of hypertension rises with increasing age, due to a significant increase in SBP largely as a result of age-related stiffening of the aorta and other large arteries, affecting almost 80% of those aged 80+ years. Appropriate management of blood pressure in this population is a priority for clinicians. Frailty is a condition characterized by marked vulnerability to adverse health outcomes and is common among older adults including those with hypertension. Hypertension increases frailty level and at the same time, individuals with increasing frailty present with more drug-related adverse effects meaning they are less tolerant to blood pressure lowering by medication. Thus, frailty is a factor that should be integrated when treating hypertension in this population. The European Society of Hypertension 2023 Guidelines on the management of Hypertension are the first international guidelines to integrate the concept of adapting blood pressure management in older adults according to their frailty/functionality level, and to propose practical tools for the application of this concept in the daily practice of physicians and other healthcare professionals. The present article prepared by the European Society of Hypertension Working Group on Hypertension in Older Adults aims to further address some important aspects mentioned concisely in the 2023 European Society of Hypertension guidelines, in order to help physicians and other healthcare professionals including those practicing in primary care. To this end, this study discusses 12 'hot questions' which are answered with the help of the 2023 European Society of Hypertension Guidelines. We hope the present article and Working Group's actions will contribute to understanding and applying the ideal management of hypertension in this most vulnerable population.

Ambulatory Blood Pressure Monitoring: Profiles in Chronic Kidney Disease Patients and Utility in Management.

Une nouvelle voie d’immunomodulation, l’induction de l’arginase par les trypanosomes chez leurs hôtes, a été identifiée et caractérisée. Pour éviter la réponse cytotoxique de l’activation « classique » M1 des macrophages et bénéficier de leur activation « alternative » M2, les parasites induisent l’arginase, qui produit la L-ornithine, indispensable à leur développement. Cette voie d’immunomodulation mise en évidence chez la souris infestée par son parasite naturel, Trypanosoma musculi, est également présente dans d’autres trypanosomoses, en particulier la trypanosomose humaine africaine (THA). Une augmentation de l’arginase, retrouvée dans le sérum de patients trypanosomés, se normalise après un traitement efficace. T. brucei gambiense, parasite de l’homme, induit l’arginase au niveau des macrophages murins et des leucocytes humains. T. lewisi, parasite du rat, induit également l’arginase. Au cours de leur longue coévolution avec leurs hôtes, les trypanosomes extracellulaires ont sélectionné un procédé favorisant leur croissance, l’induction de l’arginase, par des facteurs d’excrétion/sécrétion. Nous avons produit un anticorps monoclonal dirigé contre ce facteur inducteur. Il bloque l’induction de l’arginase par T. musculi in vitro et in vivo. Chez la souris infectée, son injection diminue considérablement la parasitémie. Il a permis l’identification du facteur inducteur, une kinésine orpheline. Cet anticorps, inhibant l’induction de l’arginase par différents trypanosomes, reconnaîtrait une région conservée de la kinésine induisant l’arginase. Cette kinésine se lie à des récepteurs de la membrane des macrophages. In vitro, l’addition de mannose à des co-cultures macrophages-parasites bloque l’induction de l’arginase et la multiplication des parasites. Chez la souris infestée par T. musculi, l’injection de mannose diminue la parasitémie, qui est également réduite chez les souris Mrc1-/-, KO pour le récepteur mannose. L’utilisation de molécules ciblant la voie inductrice de l’arginase et/ou ce récepteur peut représenter une nouvelle approche thérapeutique dans les trypanosomoses.

KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Management of Blood Pressure in CKD

Prevalence, management and control of hypertension in older adults on admission to hospital

Several important findings bearing on the prevention, detection, and management of hypertension have been reported since publication of the 2017 American College of Cardiology/American Heart Association Blood Pressure Guideline. This review summarizes and places in context the results of relevant observational studies, randomized clinical trials, and meta-analyses published between January 2018 and March 2021. Topics covered include blood pressure measurement, patient evaluation for secondary hypertension, cardiovascular disease risk assessment and blood pressure threshold for drug therapy, lifestyle and pharmacological management, treatment target blood pressure goal, management of hypertension in older adults, diabetes, chronic kidney disease, resistant hypertension, and optimization of care using patient, provider, and health system approaches. Presenting new information in each of these areas has the potential to increase hypertension awareness, treatment, and control which remain essential for the prevention of cardiovascular disease and mortality in the future.

Hypertension and Chronic Kidney Disease in the Elderly