Older patients may benefit from slightly higher blood pressure targets

In 2017, Hypertension Canada removed advanced age and frailty as considerations for caution when deciding on intensive therapy in their guidelines for the diagnosis, risk assessment, prevention, and treatment of hypertension in adults. Dementia is not mentioned. In this commentary, we review why advanced age and frailty were removed, and examine what is currently known about the relationship between hypertension and both incident and prevalent dementia. We make the case that the presence of frailty (especially when severe) and dementia should be considered when deciding on intensive therapy in future iterations of Hypertension Canada guidelines.

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Treatment of hypertension in older patients

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2020.4.9098 ◽

2020 ◽

Vol 27 (4) ◽

pp. 90-98

Author(s):

O. M. Kovalyova

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Older Patients ◽

Age Groups ◽

Blood Pressure Targets ◽

Clinical Investigations ◽

Treatment Of Hypertension ◽

American Society ◽

European Society Of Cardiology ◽

Randomised Controlled

The article is dedicated to the strategy of management of arterial hypertension in older patients based on the Guidelines of the International Society of Hypertension, the European Society of Cardiology, the European and the American Society of Hypertension, the American College of Physicians and the American Academy of Family Physicians. According to the results of epidemiological and clinical investigations is shown the influence of high blood pressure on cardiovascular outcomes and mortality in the population of older persons. Due to the analyses of randomised controlled trials is pointed out the convicing data the need for differtntiated control of blood pressure according to the level of arterial hypertension and factors of cardiovascular risk. The methodology of initial antihypertensive therapy in persons of different age groups is taken in comparative aspects. The main discussed questions related to the blood pressure targets in the dynamics of antihypertensive treatment in patients 65–79 years and age ≥ 80 years are emphasized. The requirements for individual medical tactics of older hypertensive patients taken into account anamnesis, fit and mental state, clinical features, comorbidity, complications and hypertension-mediated organ damages are recommended.

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Blood pressure lowering in the oldest old: a step toward abandoning arbitrary blood pressure targets

Journal of Hypertension ◽

10.1097/hjh.0b013e328341af1e ◽

2011 ◽

Vol 29 (1) ◽

pp. 173-175 ◽

Cited By ~ 1

Author(s):

Gianpaolo Reboldi ◽

Giorgio Gentile ◽

Fabio Angeli ◽

Paolo Verdecchia

Keyword(s):

Blood Pressure ◽

Oldest Old ◽

Blood Pressure Lowering ◽

Blood Pressure Targets ◽

Pressure Lowering

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Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

Intensive Care Medicine Experimental ◽

10.1186/s40635-019-0280-z ◽

2019 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

M. Ostermann ◽

A. Schneider ◽

T. Rimmele ◽

I. Bobek ◽

M. van Dam ◽

...

Keyword(s):

Blood Pressure ◽

Critical Care ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Future Research ◽

Knowledge Gaps ◽

Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

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Cardiovascular outcomes at recommended blood pressure targets in middle-aged and elderly patients with type 2 diabetes mellitus compared to all middle-aged and elderly hypertensive study patients with high cardiovascular risk

Blood Pressure ◽

10.1080/08037051.2020.1856642 ◽

2021 ◽

pp. 1-8

Author(s):

Eirik Olsen ◽

Björn Holzhauer ◽

Stevo Julius ◽

Sverre E. Kjeldsen ◽

Anne Cecilie K. Larstorp ◽

...

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Cardiovascular Risk ◽

Middle Aged ◽

High Cardiovascular Risk ◽

Blood Pressure Targets ◽

Elderly Hypertensive

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Effectiveness of lidocaine/prilocaine cream on cardiovascular reactions from endotracheal intubation and cough events during recovery period of older patients under general anesthesia: prospective, randomized placebo-controlled study

BMC Geriatrics ◽

10.1186/s12877-020-01567-y ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Linsheng Lv ◽

Lei Yan ◽

Xun Liu ◽

Miaoxia Chen

Keyword(s):

Blood Pressure ◽

General Anesthesia ◽

Older Patients ◽

Recovery Period ◽

Test Group ◽

Control Group ◽

Tube Cuff ◽

Group 2 ◽

Lidocaine Prilocaine ◽

Cardiovascular Reactions

Abstract Background Endotracheal intubation is known to pose significant physiological, pharmacokinetic, and dynamic changes and postoperative respiratory complications in patients under general anesthesia. Method An RCT trial was organized by the Third Affiliated Hospital at Sun Yat-sen University, China. Patients were eligible for inclusion in the trial if they were over 60 years old and had upper-abdominal surgery during the induction of anesthesia and had enrolled in endotracheal intubations. The primary end point included cardiovascular reactions during the induction of anesthesia and endotracheal intubations and cough events during the recovery period. In the test group, 2 g of lidocaine/prilocaine cream (and in the control group, 2 g of Vaseline) were laid over the surface of the tracheal tube cuff. Results The systolic blood pressure (F value = 62.271, p < 0.001), diastolic blood pressure (F value = 150.875, p < 0.001), and heart rate (F value = 75.627, p < 0.001) of the test group were significantly lower than the control group. Cough events during the recovery period in the test group were better (spontaneous cough, χ2 value = 10.591, p < 0.001; induced cough, χ2 value =10.806, p < 0.001). Conclusion In older patients, coughing and cardiovascular reactions under anesthesia and endotracheal intubations were reduced, as a result of using lidocaine/prilocaine cream on the surface of the tracheal tube cuff. Trial registration International Clinical Trials Network NCT02017392, 2013-12-16.

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