Treatment of comorbid patients over 80 years old: focus at arterial hypertension (analysis of real clinical practice)
- Authors: Safronenko V.A.1, Chesnikova A.I.1
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Affiliations:
- Rostov State Medical University of the Ministry of Healthcare of Russia
- Issue: Vol 9, No 8 (2023)
- Pages: 38-46
- Section: ORIGINAL STUDIES
- URL: https://journals.eco-vector.com/2412-4036/article/view/624617
- DOI: https://doi.org/10.18565/therapy.2023.8.38–46
- ID: 624617
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Abstract
The presence of senile asthenia syndrome (SAS) and chronic heart failure (CHF) in patients with arterial hypertension (AH) makes adjustments to the tactics of antihypertensive therapy (AHT).
The aim: estimation of the efficacy of AH outpatient treatment in elderly patients depending on CHF and SAS presence.
Material and methods. 320 patients with arterial hypertension over 80 years of age were divided into 4 groups taking into account CHF and SAS presence: 1A – a group with AH, SAS and CHF (n=84); 1B – with AH and SAS without CHF (n=84); 2A – with hypertension and CHF without SAS (n=77); 2B – with AH without CHF and without SAS (n=75). The target level of systolic blood pressure (SBP) in patients with senile asthenia is 140–150 mmHg.
Results. Patients in group 1A were more likely to have no AHT and AH monotherapy (ACE inhibitors), as well as less frequent use of triple therapy. In «strong» patients (i.e., without SAS), combination therapy was more often used to treat hypertension. Thus, in group 2B, comparatively with 2A group, the frequency of two-component therapy was higher, and when compared with group 1B, not only two-, but also three-component therapy was registered in a higher percentage of cases. In the presence of SAS in patients with hypertension, the risk of hospitalization increased by 3.57 (p=0,0002), with CHF – by 4,39 (p <0,0001), and with a combination of CHF and SAS – by 7,26 times (p <0,0001).
Conclusion. The presence of CHF and SAS worsens the AHT efficacy in hypertensive patients over 80 years old, leading to a more frequent development of orthostatic hypotension and hospitalizations due to cardiovascular events.
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About the authors
Victoria A. Safronenko
Rostov State Medical University of the Ministry of Healthcare of Russia
Author for correspondence.
Email: v.chugunova@mail.ru
ORCID iD: 0000-0002-6965-5019
PhD in Medical Sciences, associate professor of the Department of internal medicine No. 1, Rostov State Medical University of the Ministry of Healthcare of Russia
Russian Federation, Rostov-on-DonAnna I. Chesnikova
Rostov State Medical University of the Ministry of Healthcare of Russia
Email: rostov-ossn@yandex.ru
ORCID iD: 0000-0002-9323-592X
MD, professor, head of the Department of internal medicine No. 1, Rostov State Medical University of the Ministry of Healthcare of Russia
Russian Federation, Rostov-on-DonReferences
- Hu K., Zhou G., Jiang M. et al. Hypertension treatment in frail older adults: a systematic review and appraisal of guidelines. Drugs Aging. 2023; 40(10): 881–93. http://dx.doi.org/10.1007/s40266-023-01053-1.
- Boffa R.J., Constanti M., Floyd C.N., Wierzbicki A.S. Hypertension in adults: Summary of updated NICE guidance. BMJ. 2019; 367: l5310. http://dx.doi.org/10.1136/bmj.l5310.
- Muhlbauer V., Dallmeier D., Brefka S. et al. The pharmacological treatment of arterial hypertension in frail, older patients – A systematic review. Dtsch Arztebl Int. 2019; 116(3): 23–30. http://dx.doi.org/10.3238/arztebl.2019.0023.
- Липатова Т.Е., Тюльтяева Л.А., Денисова Т.П., Шульпина Н.Ю. Старческая астения и артериальная гипертензия (лекция). Саратовский научно-медицинский журнал. 2019; 15(3): 757–763. [Lipatova T.E., Tyultyaeva L.A., Denisova T.P., Shulpina N.Yu. Frailty and arterial hypertension (lecture). Saratovskiy nauchno-medicinskiy zhurnal = Saratov Journal of Medical Scientific Research. 2019; 15(3): 757–763 (In Russ.)]. EDN: AICDZZ.
- Шарашкина Н.В., Рунихина Н.К., Ткачева О.Н. Влияние ортостатической артериальной гипотензии на показатели функционального статуса у лиц пожилого и старческого возраста. Доктор.Ру. 2019; (2): 27–30. [Sharashkina N.V., Runikhina N.K., Tkacheva O.N. The effects of orthostatic hypotension on functional status parameters in elderly and very elderly people. Doctor.Ru. 2019; (2): 27–30. (In Russ.)]. http://dx.doi.org/10.31550/1727-2378-2019-157-2-27-30. EDN: ENVYNB.
- Benetos A., Petrovic M., Strandberg T. Hypertension management in older and frail older patients. Circ Res. 2019; 124(7): 1045–60. http://dx.doi.org/10.1161/CIRCRESAHA.118.313236.
- Roulet C., Rozsnyai Z., Jungo K.T. et al. Managing hypertension in frail oldest-old – The role of guideline use by general practitioners from 29 countries. PLoS ONE. 2020; 15(7): e0236064. http://dx.doi.org/10.1371/journal.pone.0236064.
- Котовская Ю.В., Ткачева О.Н., Рунихина Н.К., Остапенко В.С. Артериальная гипертония у очень пожилых: значение биологического возраста. Кардиоваскулярная терапия и профилактика. 2017; 16(3): 87–96. [Kotovskaya Yu.V., Tkacheva О.N., Rukikhina N.К., Ostapenko V.S. Arterial hypertension in a very old: significance of the biological age. Kardiovaskulyarnaya terapiya i profilaktika = Cardiovascular Therapy and Prevention. 2017; 16(3): 87–96 (In Russ.)]. http://dx.doi.org/10.15829/1728-8800-2017-3-87-96. EDN: YZIAKR.
- Голованова Е.Д. Пациенты с полиморбидностью и старческой астенией – особенности медикаментозной терапии. Клиническая геронтология. 2019; 25(7–8): 39–43. [Golovanova E.D. Peculiarities of drug therapy in geriatric patients with polymorbidity and senile asthenia. Klinicheskaya gerontologiya = Clinical Gerontology. 2019; 25(7–8): 39–43 (In Russ.)]. https://dx.doi.org/10.26347/1607-2499201907-08039-043. EDN: MMWFAS.
- Котовская Ю.В., Розанов А.В., Курашев Д.Х., Ткачева О.Н. Сердечная недостаточность и синдром старческой астении. Медицинский совет. 2018; (16): 72–79. [Kotovskaya Yu.V., Rozanov A.V., Kurashev D.H., Tkacheva O.N. Heart failure and senile asthenia syndrome. Meditsinskiy sovet = Medical Council. 2018; (16): 72–79 (In Russ.)]. https://dx.doi.org/10.21518/2079-701X-201816-72-79. EDN: XZOWVV
- Орлова Я.А., Ткачева О.Н., Арутюнов Г.П. с соавт. Особенности диагностики и лечения хронической сердечной недостаточности у пациентов пожилого и старческого возраста. Мнение экспертов Общества специалистов по сердечной недостаточности, Российской ассоциации геронтологов и гериатров и Евразийской ассоциации терапевтов. Кардиология. 2018; 58(12S): 42–72. [Orlova YA.A., Tkachyova O.N., Arutyunov G.P. et al. Features of diagnostics and treatment of chronic heart failure in elderly and senile patients. Expert opinion of the Society of Experts in Heart Failure, Russian Association of Gerontologists, and Euroasian Association of Therapists. Kardiologiya = Cardiology. 2018; 58(12S): 42–72 (In Russ.)]. https://dx.doi.org/10.18087/cardio.2560. EDN: YQZOST.
- Клинические рекомендации. Артериальная гипертензия у взрослых. Российское кардиологическое общество. Российское научное медицинское общество терапевтов. 2022. Доступ: https://scardio.ru/content/Guidelines/project/KR_AG.pdf (дата обращения – 01.10.2023). [Arterial hypertension in adults. Clinical guidelines. Russian Cardiological Society. Russian Scientific Medical Society of Internal Medicine. 2022. URL: https://scardio.ru/content/Guidelines/project/KR_AG.pdf (date of access – 01.10.2023) (In Russ.)].
- Терещенко С.Н., Галявич А.С., Ускач Т.М. с соавт. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал. 2020. 25(11): 311–374. [Tereshchenko S.N., Galyavich A.S., Uskach T.M. et al. 2020 Clinical practice guidelines for chronic heart failure. Rossiyskiy kardiologicheskiy zhurnal = Russian Journal of Cardiology. 2020. 25(11): 311–374 (In Russ.)]. https://dx.doi.org/10.15829/1560-4071-2020-4083. EDN: LJGGQV.
- Ткачева О.Н., Котовская Ю.В., Рунихина Н.К. c cоавт. Клинические рекомендации «Старческая астения». Российский журнал гериатрической медицины. 2020; (1): 11–46. [Tkacheva O.N., Kotovskaya Yu.V., Runikhina N.K. et al. Clinical guidelines on frailty. Rossiyskiy zhurnal geriatricheskoy meditsiny = Russian Journal of Geriatric Medicine. 2020; (1): 11–46 (In Russ.)]. https://dx.doi.org/10.37586/2686-8636-1-2020-11-46. EDN: JCMOSK.
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