TY - JOUR
T1 - A practical approach to the pharmacological management of hypertension in older people
AU - Parekh, Nikesh
AU - Page, Amy Theresa
AU - Ali, Khalid
AU - Davies, Kevin
AU - Rajkumar, Chakravarthi
PY - 2016/12/27
Y1 - 2016/12/27
N2 - Hypertension is the leading cause of cardiovascular (CV) morbidity and mortality in adults over the age of 65. The first part of this paper is an overview, summarizing the current guidelines on the pharmacological management of hypertension in older adults in Europe and the USA, and evidence from key trials that contributed to the guidelines. In the second part of the paper, we will discuss the major challenges of managing hypertension in the context of multimorbidity, including frailty, orthostatic hypotension (OH), falls and cognitive impairment that are associated with ageing. A novel ‘BEGIN’ algorithm is proposed for use by prescribers prior to initiating antihypertensive therapy to guide safe medication use in older adults. Practical suggestions are highlighted to aid practitioners in making rational decisions to treat and monitor hypertension, and for considering withdrawal of antihypertensive drugs in the complex older person.
AB - Hypertension is the leading cause of cardiovascular (CV) morbidity and mortality in adults over the age of 65. The first part of this paper is an overview, summarizing the current guidelines on the pharmacological management of hypertension in older adults in Europe and the USA, and evidence from key trials that contributed to the guidelines. In the second part of the paper, we will discuss the major challenges of managing hypertension in the context of multimorbidity, including frailty, orthostatic hypotension (OH), falls and cognitive impairment that are associated with ageing. A novel ‘BEGIN’ algorithm is proposed for use by prescribers prior to initiating antihypertensive therapy to guide safe medication use in older adults. Practical suggestions are highlighted to aid practitioners in making rational decisions to treat and monitor hypertension, and for considering withdrawal of antihypertensive drugs in the complex older person.
KW - hypertension
KW - medicines optimization
KW - multimorbidity
KW - older adults
UR - http://www.scopus.com/inward/record.url?scp=85018456275&partnerID=8YFLogxK
U2 - 10.1177/2042098616682721
DO - 10.1177/2042098616682721
M3 - Review Article
AN - SCOPUS:85018456275
VL - 8
SP - 117
EP - 132
JO - Therapeutic Advances in Drug Safety
JF - Therapeutic Advances in Drug Safety
SN - 2042-0986
IS - 4
ER -