To access this material please log in or register

Register Authorize

Selection of antihypertensive therapy for elderly patients

Drozdova L. Yu., Egorov V. A.
Federal State Budgetary Institution, “National Research Center for Preventive Medicine” of the RF Ministry of Health Care, Petroverigsky Per. 10, Bldg. 3, Moscow 101990

Keywords: hyperpiesis, elderly age, antihypertensive therapy, stroke, cognitive abnormality

DOI: 10.18087/rhj.2016.2.2175

This article presents results of studies focusing on efficacy and safety of antihypertensive therapy in elderly patients. Analyzed studies included primarily patients with isolated systolic AH (ISAH). According to reports of SYST-EUR and SYST-CHINA studies, treatment of elderly patients with antihypertensive drugs based on a combination of Ca2+ antagonists (CA) and ACE inhibitors (ACEI) statistically significantly reduced incidence of stroke and cardiovascular events as well as cardiovascular and all-cause mortality. Additional analysis of the continuation, open-label phase of the SYST-EUR study, which compared nitrendipine monotherapy with a nitrendipine and enalapril combination treatment showed a significant decrease in systolic BP and an additional reduction in the risk of stroke and cardiovascular complications in the combination treatment group. Notably, the treatment including the CA nitrendipine reduced incidence of cognitive disorders, which is important in selecting therapy for elderly patients with AH.
  1. Schappert SM, Burt CW. Ambulatory care visits to physician offi­ces, hospital outpatient departments, and emergency departments: United States, 2001–02. Vital Health Stat 13. 2006 Feb;159:1–66.
  2. Агеев Ф. Т., Фомин И. В., Мареев В. Ю., Беленков Ю. Н. Распро­страненность артериальной гипертонии в Европейской части Российской Федерации. Данные исследования ЭПОХА, 2003 г. Кардиология. 2004;44 (11):50–4 [Ageev F. T., Fomin I. V., Mareev V. Yu., Belenkov Yu. N. Rasprostranennost` arterial`noj gipertonii v Evropejskoj chasti Rossijskoj Federaczii. Danny`e issledovaniya E`POXA, 2003 g. Kardiologiya. 2004;44 (11):50–4].
  3. Musini VM, Tejani AM, Dassett K, Wright JM. Pharmacotherapy for hypertension in the elderly. Cochrane Database Syst Rev. 2009 Oct 7;4: CD000028.
  4. Mancia G, Fagard R, Narkewicz K, Redon J, Zanchetti A, Bohm M et al. 2013 ESH / ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013 Jul;34 (28):2159–219.
  5. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014 Feb 5;311 (5):507–20.
  6. Ambrosius WT, Sink KM, Foy CG, Berlowitz DR, Cheung AK, Cushman WC et al. The design and rationale of a multicenter clinical trial comparing two strategies for control of systolic blood pressure: the Systolic Blood Pressure Intervention Trial (SPRINT). Clin Trials. 2014 Oct;11 (5):532–46.
  7. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 rando­mised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009 May 19;338: b1665.
  8. Franklin SS, Gustin W 4th, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997 Jul 1;96 (1):308–15.
  9. Benetos A, Rudnichi A, Safar M, Guize L. Pulse pressure and cardiovascular mortality in normotensive and hypertensive subjects. Hypertension. 1998 Sep;32 (3):560–4.
  10. Neaton JD, Wentworth D. Serum cholesterol, blood pressure, cigarette smoking, and death from coronary heart disease. Overall findings and differences by age for 316,099 white men. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med. 1992 Jan;152 (1):56–64.
  11. Franklin SS, Jacobs MJ, Wong ND, L’Italien GJ, Lapuerta P. Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: analysis based on National Health and Nutrition Examination Survey (NHANES) III. Hypertension. 2001 Mar;37 (3):869–74.
  12. Staessen J, Amery A, Fagard R. Isolated systolic hypertension in the elderly. J Hypertens. 1990 May;8 (5):393–405.
  13. MRC trial of treatment of mild hypertension. BMJ (Clin Res Ed). 1985 Jul 27;291 (6490):277–8.
  14. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. JAMA. 1991 Jun 26;265 (24):3255–64.
  15. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhager WH et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997 Sep 13;350 (9080):757–64.
  16. Liu L, Wang JG, Gong L, Liu G, Staessen JA. Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens. 1998 Dec;16 (12 Pt 1):1823–9.
  17. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008 May 1;358 (18):1887–98.
  18. Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ. 2003 Jun 28;326 (7404):1427.
  19. Sica DA. Rationale for fixed-dose combinations in the treatment of hypertension: the cycle repeats. Drugs. 2002;62 (3):443–62.
  20. Jamerson K, Weber MA, Bakris GL, Dahlof B, Pitt B, Shi V et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008 Dec 4;359 (23):2417–28.
  21. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015 Aug 22;386 (9995):743–800.
  22. Nagai M, Hoshide S, Kario K. Hypertension and dementia. Am J Hypertens. 2010 Feb;23 (2):116–24.
  23. Forette F, Seux ML, Staessen JA, Thijs L, Babarskiene MR, Babeanu S et al. The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med. 2002 Oct 14;162 (18):2046–52.
  24. Trompet S, Westendorp RG, Kamper AM, de Craen AJ. Use of calcium antagonists and cognitive decline in old age. The Leiden 85‑plus study. Neurobiol Aging. 2008 Feb;29 (2):306–8.
  25. Hosie J, Wiklund I. Managing hypertension in general practice: can we do better? J Hum Hypertens. 1995 Jul;9 (Suppl 2):S15–8.
  26. Graves JW. Management of difficult to control hypertension. Mayo Clin Proc. 2000 Mar;75 (3):278–84.
Drozdova L. Yu., Egorov V. A. Selection of antihypertensive therapy for elderly patients. Russian Heart Journal. 2016;15 (2):123–126

To access this material please log in or register

Register Authorize
Ru En