Protocolo diagnóstico y tratamiento de la hipertensión arterial en el anciano

Abstract

Hypertension (HT) is defined in Europe as the presence of persistently high figures of systolic blood pressure (SBP) equal to or higher than 140mm Hg, or a diastolic blood pressure (DPB) equal to or higher than 90mm Hg. In elderly patients the control target is considered to be a SBP from 130 to 140mm Hg and a DPB of from 70 to 79mm Hg. The impact of reducing BP on the wellbeing of patients should be closely monitored, as lower BP figures increase the risk of adverse events such as injury due to falls. An appropriate anamnesis at the moment HT is diagnosed is of key important, together with physical examination and the request for complementary tests. The available evidence supports the recommendation to offer antihypertensive treatment to elderly patients (over the age of 65 years, and even to those over the age of 80 years) with a SBP equal to or higher than 160mm Hg. Hygienic-dietary measures and lifestyle changes are justified in all cases. Respecting medical treatment, a threshold of SBP greater than or equal to 140mm Hg is set for patients aged from 65 to 79 years, or a SBP greater than or equal to 160mm Hg for patients over the age of 80 years. It is important to point out that even in very elderly patients (over the age of 80 years), antihypertensive treatment reduces mortality, ictus and heart failure. Treatment should therefore never be refused or withdrawn from these patients solely due to their age.