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REFLECTIONS
Hypertension
Hypertension Global Newsletter #5 2023

SPECIAL POPULATIONS – ELDERLY Hypertension

Antihypertensive treatment in people of very old age with frailty: Time for a
paradigm shift?
Shantsila E, et al. J Hypertens. 2023 Jul 6. doi: 10.1097/HJH.0000000000003495. Online ahead of print.

While 25% of all adults and 75% of adults older than 75 years pharmacotherapy in people aged ≥80 years, only the HYVET
are currently on BP-lowering treatment, there remain multiple Trial focused on people in this age group and assessed
gaps in evidence to support the optimal management of their frailty status. Compared to placebo, antihypertensive
hypertension in elderly patients. Elderly people have limited treatment (indapamide, perindopril) reduced the risk of stroke,
life expectancy and so quality of life may be prioritized. This HF, overall and CV mortality, with fewer adverse effects.
in-depth review article examines the current evidence of
managing hypertension in individuals aged ≥80 years with The authors review the many factors that affect BP control
frailty. in older patients with frailty, including age-related factors
with regard to arterial stiffening, baroreflex sensitivity,
The authors note that clinical trials normally exclude people post-prandial hypotension, kidney sensitivity to sodium
with multimorbidity and polypharmacy, typical in the frail cardiac fibrosis, cognitive changes, and basal metabolism
elderly population. In addition, there is no universally rate. With regards to frailty, there is a reduction in
accepted clinical research method to diagnose and quantify multisystem adaptation to stressors, a reduction in BP
frailty; therefore, its definition varies between studies. and BP fluctuations, along with autonomic dysfunction.
These together can contribute to a changed response to
Of the six main placebo-controlled RCTs of antihypertensive pharmacotherapy.

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