Screening and treatment of hypertension in older adults : less is more ?

Anker, Daniela (Institute of Primary Health Care (BIHAM), University of Bern) ; Santos-Eggimann, Brigitte (Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital) ; Santschi, Valérie (Institut et Haute Ecole de la Santé La Source, HES-SO Haute école spécialisée de Suisse occidentale) ; Del Giovane, Cinzia (Institute of Primary Health Care (BIHAM), University of Bern) ; Wolfson, Christina (Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal) ; Streit, Seven (Institute of Primary Health Care (BIHAM), University of Bern, Bern) ; Rodondi, Nicolas (Institute of Primary Health Care (BIHAM), University of Bern ; Department of General Internal Medicine, Inselspital, Bern University Hospital) ; Chiolero, Arnaud (Institute of Primary Health Care (BIHAM), University of Bern ; Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital ; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal)

Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one hand, there is robust evidence that screening and treatment of hypertension prevents CVD and decreases mortality in the middle-aged population. On the other hand, among older adults, observational studies have shown either positive, negative, or no correlation between blood pressure (BP) and cardiovascular outcomes. Furthermore, there is a lack of high quality evidence for a favorable harm-benefit balance of antihypertensive treatment among older adults, especially among the oldest-old (i.e., above the age of 80 years), because very few trials have been conducted in this population. The optimal target BP may be higher among older treated hypertensive patients than among middle-aged. In addition, among frail or multimorbid older individuals, a relatively low BP may be associated with worse outcomes, and antihypertensive treatment may cause more harm than benefit. To guide hypertension screening and treatment recommendations among older patients, additional studies are needed to determine the most efficient screening strategies, to evaluate the effect of lowering BP on CVD risk and on mortality, to determine the optimal target BP, and to better understand the relationship between BP, frailty, multimorbidity, and health outcomes.


Keywords:
Article Type:
scientifique
Faculty:
Santé
School:
La Source
Institute:
Secteur Recherche et Développement (Ra&D) de l'Institut et Haute Ecole de la Santé La Source
Subject(s):
Santé
Date:
2018-01
Pagination:
16 p.
Published in:
Public Health Reviews
Numeration (vol. no.):
2018, vol. 39, no. 26
DOI:
ISSN:
2107-6952
Appears in Collection:



 Record created 2019-02-08, last modified 2019-10-07

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