How Low Should We Go? Managing Hypertension in Older People.

Abstract

This issue of The Senior Care Pharmacist includes the first of three articles related to hypertension management. These review key clinical trials regarding the evidence for treating hypertension, with a focus on older people. The first part of the series covers three key clinical trials that provide evidence related to intensive blood pressure control (below the systolic target of 140 mm Hg and closer to 120 mm Hg) in adults older than 75 years of age: HYVET, SPRINT, and STEP. These trials reiterate that older people can gain cardiovascular and mortality benefits from intensive blood pressure-lowering--but at what cost? Antihypertensive agents come with risks, most commonly hypotension, syncope, falls, electrolyte abnormalities, and acute kidney injury or failure. Pill burden is a concern, as many older people need multiple antihypertensive agents to control their blood pressure. Parts two and three of this series will explore some of the negative outcomes that can occur from going too low with intensive blood pressure control and will discuss aspects of deprescribing.