Treatment of hypertension in older patients in 2024: What’s new?

Abstract

Older individuals represent the greatest proportion of patients with arterial hypertension. For several decades, the management of old (>60-65 years) and very old (>80 years) patients with hypertension has been relatively conservative because of the paucity of scientific evidence of clinical benefits and the fear of doing more harm than good. Yet, in recent years, major changes in the therapeutic approach of older hypertensive patients have occurred leading to lower thresholds and treatment targets in most recent guidelines such as those of the European Society of Hypertension. These latter now emphasize the need to assess frailty properly in all older patients to propose the most accurate drug treatments, to start antihypertensive therapy prudently with a monotherapy in very old hypertensive patients (>80 years) and to reassess periodically the overall medications to avoid overtreatments. In this review, the recent changes in the management of older patients are discussed comparing several recent recommendations from national and international guidelines.