Rational antihypertensive therapy of older patients

Main Article Content

O. M. Kovalyova

Abstract

The article is devoted to the consideration of hypertensive older patients management with accent on pharmacological treatment. For justification of the choice of antihypertensive drugs on the principles of the evidence-based medicine the results of a randomized controlled clinical trials with inclusion of the old and older hypertensive patients are shown. Асcording to published systematic reviews and meta-analysis in comparative aspects are given the effects of different antihypertensive drugs related to their influence on cardiovascular events in this category of patients. Recommendations of rational pharmacotherapy of hypertension relevant to age-specific features of patients are taken with variant positions according to suggestions of leading experts and international organizations – the European Society of Cardiology; the European Society of Hypertension; American Society of Hypertension; the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the Management of Hypertension in Very Old, Frail Subjects; Canadian Hypertension Education Program; the American College of Physicians and the American Academy of Family Physicians; National Institute for Health and Clinical Excellence. The tactic of treatment of geriatric patients with hypertension is summarized.

Article Details

Keywords:

hypertension, old and older age, randomized controlled clinical trials, antihypertensive drugs

References

Alhawassi T., Krass I., Pont L. Hypertension in older persons: a systematic review of national and international treatment guidelines // J. Clin. Hypertens. (Greenwich).– 2015.– Vol. 17.– P. 486–492. doi: 10.1111/jch.12536.

ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) // JAMA.– 2002.– Vol. 288.– P. 2981–2997.

Aronow W.A., Fleg J.L., Pepine C.J. et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly:

a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents // Circulation.– 2011.– Vol. 123.– P. 2434–2506.

doi: 10.1161/CIR.0b013e31821daaf6.

Bavishi C., Ahmed M., Trivedi V. et. al. Meta-analysis of randomized trials on the efficacy and safety of angiotensin-converting enzyme inhibitors in patients ≥ 65 years of age // Am. J. Cardiol.– 2016.– Vol. 118.– P. 1427–1436.

doi: 10.1016/j.amjcard.2016.07.074.

Beckett N.S., Peters R., Fletcher A.E et al. HYVET Study Group. Treatment of hypertension in patients 80 years of age or older // New Engl. J. Med.– 2008.– Vol. 358 (18).– P. 1887–1898. doi: 10.1056/NEJMoa0801369.

Benetos A., Petrovic M., Strandberg T. Hypertension management in older and frail older patients 2019 // Circulation Research.– 2019.– Vol. 124.– P. 1045–1060. doi: 10.1161/CIRCRESAHA.118.313236.

Briasoulis A., Agarwal V., Tousoulis D. et al. Effects of antihypertensive treatment in patients over 65 years of age: a meta-analysis of randomised controlled studies // Heart.– 2014.– Vol. 100.– P. 317–323. doi: 10.1136/heartjnl-2013-304111.

Cooper-DeHoff R.M., Handberg E.M., Mancia G. et al. INVEST revisited: review of findings from the International Verapamil SR-Trandolapril Study // Expert Rev. Cardiovasc. Ther.– 2009.– Vol. 7.– P. 1329–1333. doi: 10.1586/erc.09.102.

Corrao G., Mazzola P., Monzio Compagnoni M. et al. Antihypertensive medications, loop diuretics, and risk of hip fracture in the elderly: a population-based cohort study of 81,617 Italian patients newly treated between 2005 and 2009 // Drugs Aging.– 2015.– Vol. 32 (11).– P. 927–936. doi: 10.1007/s40266-015-0306-5.

Cruickshank J.M. The Role of Beta-Blockers in the Treatment of Hypertension // Adv. Exp. Med. Biol.– 2017.– Vol. 956.– P. 149–166. doi: 10.1007/5584_2016_36.

Duprez D.A., Munger M.A., Botha J. et al. Aliskiren for Geriatric Lowering of Systolic Hypertension: a randomized controlled trial // J. Hum. Hypertens.– 2010.– Vol. 24.– P. 600–608. doi: 10.1038/jhh.2009.107.

Gąsowski J., Piotrowicz K., Messerli F.H. Arterial hypertension after age 65: from epidemiology and pathophysiology to therapy. Do we know where we stand? // Kardiol. Pol.– 2018.– Vol. 76 (4).– P. 723–730. doi: 10.5603/KP.2018.0075.

Kolloch R., Legler U.F., Champion A. et al. Impact of resting heart rate on outcome in hypertensive patients with coronary artery disease finding from the International Verapamil SR/Trandolapril study (INVEST) // Eur. Heart J.– 2008.– Vol. 29.– P. 1327–1334. doi: 10.1093/eurheartj/ehn123.

Lacourcière Y. A multicenter, randomized, double-blind study of the antihypertensive efficacy and tolerability of irbesartan in patients aged > or = 65 years with mild to moderate hypertension // Clin. Ther.– 2000.– Vol. 22 (10).– P. 1213–1224. doi: 10.1016/s0149-2918(00)83064-7.

Law M.R., Morris J.K., Wald N.J. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of ex expectations from prospective epidemiological studies // Brit. Med. J.– 2009.– Vol. 338.– P. 1–19. doi: 10.1136/bmj.b1665.

Lindholm L.H., Ibsen H., Dahlöf B. et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomized trial against atenolol // Lancet.– 2002.– Vol. 359.– P. 1004–1010.

Lindon M. H., Wing O.A.M., MBBS(Hons), FRACP Treatment of hypertension in older people // J. Farmacy Pract. Research.– 2018.– Vol. 48, Issue 1 Pages.– P. 92–101.

doi: 10.1016/S0140-6736(02).

Lithell H., Hansson L., Skoog I. et al. The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial // J. Hypertens.– 2003.– Vol. 21.– P. 875–886. doi: 10.1097/00004872-200305000-00011.

Mancia G., Fagard R., Narkiewicz K. 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.– Vol. 34.– P. 2159–2219. doi: 10.1093/eurheartj/eht151.

Messerli F.H., Grossman E., Goldbourr U. Are beta-blockers efficacious as first-line therapy for hypertension in the eldery? A systematic review // JAMA.– 1998.– Vol. 279.– P. 1903–1907. doi: 10.1001/jama.279.23.1903.

Messerli F.H., Bangalore S., Bavishi C. еt. al. Angiotensin-converting enzyme inhibitors in hypertension: to use or not to use? // J. Am. Coll. Cardiol.– 2018.– Vol. 71.– P. 1474–1482. doi: 10.1016/j.jacc.2018.01.058.

Musini V.M., Tejani A.M., Bassett K.R. et al. and Cochrane Hypertension Group Pharmacotherapy for hypertension in adults 60 years or older // Cochrane Database Syst Rev.– 2019.– Vol. 6 (6).– P. CD000028. doi: 10.1002/14651858.CD000028.pub3.

Mizuno H., Hoshide S., Fukutomi M. et al. Differing Effects of aliskiren/amlodipine combination and high-dose amlodipine monotherapy on ambulatory blood pressure and target organ protection // J. Clin. Hypertens.– 2016.– Vol. 18.– P. 70–78. doi: 10.1111/jch.12618.

Oliveros E., Patel H., Kyung S. Hypertension in older adults: Assessment, management, and challenges // Clin. Cardiology.– 2019.– Vol. 1–9. doi: 10.1002/clc.23303.

Pantzaris N.-D., Karanikolas E., Tsiotsios K. et al. Renin Inhibition with Aliskiren: A Decade of Clinical Experience // J. Clin. Med.– 2017.– Vol. 6 (61).– P. 2–19. doi: 10.3390/jcm6060061.

Parekh N., Page A., Khalid Ali K. et al. A practical approach to the pharmacological management of hypertension in older people // Ther. Adv. Drug. Saf.– 2017.– Vol. 8 (4).– P. 117–132. doi: 10.1177/2042098616682721.

Protogerou A.D., Stergiou G.S., Vlachopoulos C. et al. The effect of antihypertensive drugs on central blood pressure beyond peripheral blood pressure. Part II: evidence for specific class-effects of antihypertensive drugs on pressure amplification // Curr. Pharm. Des.– 2009.– Vol. 15.– P. 272–289. doi: 10.2174/​138161209787354186.

Qaseem A., Wilt T.J., Rich R. et al. Clinical Guidelines Committee of the American College of Physicians and the Commission on Health of the Public and Science of the American Academy of Family Physicians. Pharmacologic treatment of hypertension in adults aged 60 years or older to higher versus lower blood pressure targets: a clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians // Ann. Intern. Med.– 2017.– Vol. 166.– P. 430–437. doi: 10.7326/M16-1785.

Quang T. Nguyen, Scott R. Anderson, Lindsay Sanders et al. Managing Hypertension in the Elderly: A Common Chronic Disease with Increasing Age // Am. Health Drug. Benefits.– 2012.– Vol. 5 (3).– P. 146–153.

Staessen J.A., Fagard R., Thijs L. 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.– Vol. 350.– P. 757–764. doi: 10.1016/s0140-6736(​97)05381-6.

Teo K.K., Pfeffer M., Mancia G. et al. Aliskiren Prevention of Later Life Outcomes trial Investigators Aliskiren alone or with other antihypertensives in the elderly with borderline and stage 1 hypertension: The APOLLO trial // Eur. Heart J.– 2014.– Vol. 35.– P. 1743–1751.

Thomopoulos C., Parati G., Zanchetti A. Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 14 – effects of different classes of antihypertensive drugs in older and younger patients: overview and meta-analysis // J. Hypertens.– 2018.– Vol. 36 (8).– P. 1637–1647. doi: 10.1097/HJH.0000000000001777.

Weiss R.J., Weber M.A., Carr A.A. et al. A randomized, double-blind, placebo-controlled parallel-group study to assess the efficacy and safety of nebivolol, a novel beta-blocker, in patients with mild to moderate hypertension // J. Clin. Hypertens. (Greenwich).– 2007.– Vol. 9.– P. 667–676. doi: 10.1111/j.1524-6175.2007.06679.x.

Wing L.M.H., Reid C.M., Ryan P. et al. A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly // New Engl. J. Med.– 2003.– Vol. 348.– P. 583–592. doi: 10.1056/NEJMoa021716.

Yano Y., Rakudi H., Barkis G. K. On treatment blood pressure and cardiovascular outcomes in older adults with isolated systolic hypertension // Hypertension.– 2017.– Vol. 69 (2).– P. 220–227. doi: 10.1161/HYPERTENSIONAHA.116.08600.

Yusuf S., Sleight P., Pogue J. et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high risk patients. The Heart Outcomes Prevention Evaluation Study Investigators // New Engl. J. Med.–

– Vol. 342.– P. 145–153. doi: 10.1056/NEJM200001203420301.

Zanchetti A., Dominiczak A., Coca A. et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension

// Eur. Heart J.– 2018.– Vol. 39 (33).– P. 3021–3104.

doi: 10.1093/eurheartj/ehy339.