ELDERLY PATIENT WITH ARTERIAL HYPERTENSION: FOCUS AT THERAPY INDIVIDUALIZATION


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Abstract

Arterial hypertension (AH) in elderly patients preserves its role as a risk factor for cardiovascular morbidity and mortality, while data from observational studies on the inverse relationship between blood pressure levels and life prognosis in patients with senile asthenia bring complex practical questions for the doctor concerning the use of antihypertensive medicaments. It is important that the decision on the tactics of antihypertensive therapy in older patients is made taking into account their functional status, presence of senile asthenia, and degree of autonomy preservation.

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About the authors

Yulia V. Kotovskaya

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia - Russian Gerontological Research and Clinical Center

Email: kotovskaya_yv@rgnkc.ru
Dr. med. habil., professor, deputy director for research work 129226, Moscow, 16 1st Leonova Str

References

  1. Angelousi A., Girerd N., Benetos A. et al. Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: A systematic review and meta-analysis. J Hypertens. 2014; 32(8): 1562-71; discussion 1571. https://dx.doi.org/10.1097/HJH.0000000000000235.
  2. Ткачева О.Н., Котовская Ю.В., Рунихина Н.К. с соавт. Артериальная гипертония и антигипертензивная терапия у пациентов старших возрастных групп. Согласованное мнение экспертов Российской ассоциации геронтологов и гериатров, Антигипертензивной Лиги, Национального общества профилактической кардиологии. Рациональная фармакотерапия в кардиологии. 2021; 17(4): 642-661.
  3. Lewington S., Clarke R., Qizilbash N. et al.; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360(9349): 1903-13. https://dx.doi.org/10.1016/S0140-6736(02)11911-8
  4. Benetos A., Petrovic M., Strandberg T. Hypertension management in older and frail older patients. Circ Res. 2019; 124(7): 1045-60. https://dx.doi.org/10.1161/CIRCRESAHA.118.313236.
  5. Walker K.A., Sharrett A.R., Wu A. et al. Association of midlife to late-life blood pressure patterns. JAMA. 2019; 322(6): 535-45. https://dx.doi.org/10.1001/jama.2019.10575.
  6. Beckett N.S., Peters R., Fletcher A.E. et al.; HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008; 358(18): 1887-98. https://dx.doi.org/10.1056/NEJMoa0801369.
  7. Williamson J.D., Supiano M.A., Applegate W.B. et al; SPRINT Research Group.Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged s75 years: A randomized clinical trial. JAMA. 2016; 315(24): 2673-82. https://dx.doi.org/10.1001/jama.2016.7050.
  8. Warwick J., Falaschetti E., Rockwood K. et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Med. 2015; 13: 78. https://dx.doi.org/10.1186/s12916-015-0328-1.
  9. Forette F., Seux M., Staessen J. et al. Prevention of dementia in a randomised double blind placebo controlled systolic hypertension in Europe (Syst-Eur) trial. Lancet. 1998; 352(9137): 1347-51. https://dx.doi.org/10.1016/s0140-6736(98)03086-4.
  10. Lithell H., Hansson L., Skoog I. et al.; SCOPE Study Group. The Study on Cognition and Prognosis in the Elderly (SCOPE): Principal results of a randomized double-blind intervention trial. J Hypertens. 2003; 21(5): 875-86. https://dx.doi.org/10.1097/00004872-200305000-00011.
  11. Saxby B.K., Harrington F., Wesnes K.A. et al. Candesartan and cognitive decline in older patients with hypertension: A substudy of the SCOPE trial. Neurology. 2008; 70(19 Pt 2): 1858-66. https://dx.doi.org/10.1212/01.wnl.0000311447.85948.78.
  12. Lebouvier T., Chen Y., Duriez P. et al. Antihypertensive agents in Alzheimer's disease: beyond vascular protection. Expert Rev Neurother. 2020; 20(2): 175-87. https://dx.doi.org/10.1080/14737175.2020.1708195.
  13. Peters R., Beckett N., Forette F. et al; HYVET Investigators. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): A double-blind, placebo controlled trial. Lancet Neurol. 2008; 7(8): 683-89. https://dx.doi.org/10.1016/S1474-4422(08)70143-1.
  14. SPRINT MIND Investigators for the SPRINT Research Group, Williamson J.D., Pajewski N.M., Auchus A.P. et al. Effect of intensive vs standard blood pressure control on probable dementia: A randomized clinical trial. JAMA. 2019; 321(6): 553-61. https://dx.doi.org/10.1001/jama.2018.21442.
  15. Aparicio L.S., Thijs L., Boggia J. et al; International Database on Home Blood Pressure in Relation to Cardiovascular Outcome (IDHOCO) Investigators. Defining thresholds for home blood pressure monitoring in octogenarians. Hypertension. 2015; 66(4): 865-73. https://dx.doi.org/10.1161/HYPERTENSIONAHA.115.05800.
  16. Benetos A., Labat C., Rossignol P. et al. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: the PARTAGE study. JAMA Intern Med. 2015; 175(6): 989-95. https://dx.doi.org/10.1001/jamainternmed.2014.8012.
  17. Mossello E., Pieraccioli M., Nesti N. et al. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med. 2015; 175(4): 578-85. https://dx.doi.org/10.1001/jamainternmed.2014.8164.
  18. Streit S., Poortvliet R.K.E., Gussekloo J. Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old-data from the Leiden 85-plus study. Age Ageing. 2018; 47(4): 545-50. https://dx.doi.org/10.1093/ageing/afy072.
  19. Ткачева О.Н., Котовская Ю.В., Рунихина Н.К. с соавт. Клинические рекомендации «Старческая астения». Российский журнал гериатрической медицины. 2020; 1: 11-46.
  20. Ткачева О.Н., Котовская Ю.В., Рунихина Н.К. с соавт. Клинические рекомендации «Старческая астения». Часть 2. Российский журнал гериатрической медицины. 2020; 2: 115-130
  21. Клинические рекомендации. Артериальная гипертензия у взрослых. Российское кардиологическое общество. Рубрикатор клинических рекомендаций Минздрава России. 2020. ID: 62. Доступ: https://cr.minzdrav.gov.ru/schema/62_2 (дата обращения -01.11.2022)
  22. Schiavi P., Jochemsen R., Guez D. Pharmacokinetics of sustained and immediate release formulations of indapamide after single and repeated oral administration in healthy volunteers. Fundam Clin Pharmacol. 2000; 14(2): 139-46. https ://dx.doi.org/10.1111/j.1472-8206.2000.tb00402.x.
  23. Waeber B., Rotaru C., Feihl F. Position of indapamide, a diuretic with vasorelaxant activities, in antihypertensive therapy. Expert Opin Pharmacother. 2012; 13(10): 1515-26. https://dx.doi.org/10.1517/14656566.2012.698611.
  24. PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischaemic attack. Lancet. 2001; 358(9287): 1033-41. https://dx.doi.org/10.1016/S0140-6736(01)06178-5.
  25. Thomopoulos C., Parati G., Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension: 4. Effects of various classes of antihypertensive drugs - overview and meta-analyses. J Hypertens. 2015; 33(2): 195-211. https://dx.doi.org/10.1097/HJH.0000000000000447.
  26. National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management. Clinical guideline [CG127]. 24 August 2011. URL: https://www.nice.org.uk/guidance/cg127 (date of access - 01.11.2022).
  27. Burnier M., Bakris G., Williams B. Redefining diuretics use in hypertension: Why select a thiazide-like diuretic? J Hypertens. 2019; 37(8): 1574-86. https://dx.doi.org/10.1097/HJH.0000000000002088.

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