A practical approach to the pharmacological management of hypertension in older people

Nikesh Parekh, Amy Theresa Page, Khalid Ali, Kevin Davies, Chakravarthi Rajkumar

Research output: Contribution to journalReview ArticleResearchpeer-review

17 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)117-132
Number of pages16
JournalTherapeutic Advances in Drug Safety
Issue number4
Publication statusPublished - 27 Dec 2016
Externally publishedYes


  • hypertension
  • medicines optimization
  • multimorbidity
  • older adults

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