Abstract
The recommendations of international scientific societies for the treatment of hypertension in the geriatric population are different. Lack of outcome trials, non-standardised terminology as well as differing levels of evidence contribute to the inconsistencies in the guidelines. This review article compares six international guidelines (ESH-ESC 2007/2009, SHG 2009, DHL 2008, CHEP 2010, NICE 2011 and JNC7 2003) as well as the consensus document of the ACCF/AHA 2011 in terms of their recommendations of drug classes, target blood pressure values and the use of combination therapy. Generally, antihypertensive therapy appears to be clinically beneficial in geriatric patients. Target blood pressure values of <140-150/90 mm Hg and <140/90 mm Hg can be used as a general guideline for octogenarians (80-89 yrs) and septuagenarians (70-79 yrs) respectively. While angiotensin-II converting enzyme inhibitors and diuretics appear to be advantageous in treating combined systolic-diastolic hypertension, calcium-channel blockers and diuretics are to be recommended in the management of isolated systolic hypertension. Combination therapy often increases the efficacy of the treatment as well as patient medication adherence. Furthermore, by making the most of drug combination synergy, lower doses may be used resulting in fewer side-effects.
Highlights
It is estimated that, by 2050, approximately a fifth of the global geriatric population will be 80 years or above [1]
The rapid release of new data within the last few years is not yet reflected by all national societies, making such information inaccessible to health practioners and patients alike. – Lack of evidence: target blood pressure (BP) are not clearly defined and are mainly based on expert opinion. – Varying level of evidence: There is disparity amongst different guidelines with regards to the level of evidence upon which recommendations are based. – Non-standardised terminology: Almost all published guidelines, use different or novel terms for defining age ranges within the geriatric populace. – Different approaches for the use of combined therapy: Therapy failure is often due to the apprehension of side effects and an increased pill burden which results in poor adherence in the elderly
The aim of this review is to investigate six international guidelines with respect to their recommendations on target BPs, drug classes and combination therapy for old and very old patients and to highlight the current information in the Consensus Document of the American College of Cardiology Foundation / American Heart Association (ACCF / AHA 2011) [3]
Summary
The recommendations of international scientific societies for the treatment of hypertension in the geriatric population are different. Non-standardised terminology as well as differing levels of evidence contribute to the inconsistencies in the guidelines. This review article compares six international guidelines (ESH-ESC 2007/ 2009, SHG 2009, DHL 2008, CHEP 2010, NICE 2011 and JNC7 2003) as well as the consensus document of the ACCF/AHA 2011 in terms of their recommendations of drug classes, target blood pressure values and the use of combination therapy. Antihypertensive therapy appears to be clinically beneficial in geriatric patients. Target blood pressure values of
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