Screening and treatment of hypertension in older adults: less is more?
Abstract Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one...
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doaj-1b57438c186646798b18c885357970872021-04-02T11:24:28ZengFrontiers Media S.A.Public Health Reviews2107-69522018-09-0139111610.1186/s40985-018-0101-zScreening and treatment of hypertension in older adults: less is more?Daniela Anker0Brigitte Santos-Eggimann1Valérie Santschi2Cinzia Del Giovane3Christina Wolfson4Sven Streit5Nicolas Rodondi6Arnaud Chiolero7Institute of Primary Health Care (BIHAM), University of BernInstitute of Social and Preventive Medicine (IUMSP), Lausanne University HospitalLa Source, School of Nursing Sciences, University of Applied Sciences and Arts Western SwitzerlandInstitute of Primary Health Care (BIHAM), University of BernDepartment of Epidemiology, Biostatistics and Occupational Health, McGill UniversityInstitute of Primary Health Care (BIHAM), University of BernInstitute of Primary Health Care (BIHAM), University of BernInstitute of Primary Health Care (BIHAM), University of BernAbstract Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one hand, there is robust evidence that screening and treatment of hypertension prevents CVD and decreases mortality in the middle-aged population. On the other hand, among older adults, observational studies have shown either positive, negative, or no correlation between blood pressure (BP) and cardiovascular outcomes. Furthermore, there is a lack of high quality evidence for a favorable harm-benefit balance of antihypertensive treatment among older adults, especially among the oldest-old (i.e., above the age of 80 years), because very few trials have been conducted in this population. The optimal target BP may be higher among older treated hypertensive patients than among middle-aged. In addition, among frail or multimorbid older individuals, a relatively low BP may be associated with worse outcomes, and antihypertensive treatment may cause more harm than benefit. To guide hypertension screening and treatment recommendations among older patients, additional studies are needed to determine the most efficient screening strategies, to evaluate the effect of lowering BP on CVD risk and on mortality, to determine the optimal target BP, and to better understand the relationship between BP, frailty, multimorbidity, and health outcomes.http://link.springer.com/article/10.1186/s40985-018-0101-zScreeningHypertensionOlder adultsFrailty |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Daniela Anker Brigitte Santos-Eggimann Valérie Santschi Cinzia Del Giovane Christina Wolfson Sven Streit Nicolas Rodondi Arnaud Chiolero |
spellingShingle |
Daniela Anker Brigitte Santos-Eggimann Valérie Santschi Cinzia Del Giovane Christina Wolfson Sven Streit Nicolas Rodondi Arnaud Chiolero Screening and treatment of hypertension in older adults: less is more? Public Health Reviews Screening Hypertension Older adults Frailty |
author_facet |
Daniela Anker Brigitte Santos-Eggimann Valérie Santschi Cinzia Del Giovane Christina Wolfson Sven Streit Nicolas Rodondi Arnaud Chiolero |
author_sort |
Daniela Anker |
title |
Screening and treatment of hypertension in older adults: less is more? |
title_short |
Screening and treatment of hypertension in older adults: less is more? |
title_full |
Screening and treatment of hypertension in older adults: less is more? |
title_fullStr |
Screening and treatment of hypertension in older adults: less is more? |
title_full_unstemmed |
Screening and treatment of hypertension in older adults: less is more? |
title_sort |
screening and treatment of hypertension in older adults: less is more? |
publisher |
Frontiers Media S.A. |
series |
Public Health Reviews |
issn |
2107-6952 |
publishDate |
2018-09-01 |
description |
Abstract Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one hand, there is robust evidence that screening and treatment of hypertension prevents CVD and decreases mortality in the middle-aged population. On the other hand, among older adults, observational studies have shown either positive, negative, or no correlation between blood pressure (BP) and cardiovascular outcomes. Furthermore, there is a lack of high quality evidence for a favorable harm-benefit balance of antihypertensive treatment among older adults, especially among the oldest-old (i.e., above the age of 80 years), because very few trials have been conducted in this population. The optimal target BP may be higher among older treated hypertensive patients than among middle-aged. In addition, among frail or multimorbid older individuals, a relatively low BP may be associated with worse outcomes, and antihypertensive treatment may cause more harm than benefit. To guide hypertension screening and treatment recommendations among older patients, additional studies are needed to determine the most efficient screening strategies, to evaluate the effect of lowering BP on CVD risk and on mortality, to determine the optimal target BP, and to better understand the relationship between BP, frailty, multimorbidity, and health outcomes. |
topic |
Screening Hypertension Older adults Frailty |
url |
http://link.springer.com/article/10.1186/s40985-018-0101-z |
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