A Review of Clinical Guidelines and Pharmacotherapeutic Management of Hypertension in Older Adults

2019 ◽  
Vol 34 (2) ◽  
pp. 86-98
Author(s):  
Jelena Lewis ◽  
Tania Gregorian ◽  
Ashley M. Huntsberry ◽  
Laura V. Tsu
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Adverse Drug Events ◽  
Data Extraction ◽  
Adult Population ◽  
Research Review ◽  
Original Research ◽  
Blood Pressure Targets ◽  
Common Chronic Disease ◽  
Pubmed Search

OBJECTIVE: To provide an up-to-date review of current hypertension (HTN) guidelines and discuss pharmacotherapeutic management of HTN in the older adult population.<br/> DATA SOURCES: A PubMed search of articles published through June 2018 was performed using a combination of the following words: elderly, older adults, geriatric, and HTN.<br/> STUDY SELECTION/DATA EXTRACTION: Relevant original research, review articles, and guidelines were assessed for the management of HTN in older adults. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, complete results, and after a thorough discussion among the authors.<br/> DATA SYNTHESIS: HTN is a common chronic disease state in older adults. Until recently, most guidelines recommended a higher threshold for blood pressure targets in this population, compared with the general adult population. In 2017, two new guidelines for the management of HTN were published, which provided conflicting recommendations for blood pressure goals in the older population. This article reviews current U. S. HTN guidelines published in 2014 to 2017 that most commonly influence patient care, and it specifically addresses the blood pressure targets and pharmacotherapeutic management of HTN in older adults.<br/> CONCLUSION: Management of HTN in older adults is important to avoid further complications and improve outcomes in this population. Blood pressure targets and HTN management should be individualized in older adults based on comorbid conditions, life expectancy, and risk for adverse drug events.

Pharmacological Management of Hyperlipidemia in Older individuals

2021 ◽  
Vol 36 (6) ◽  
pp. 284-303
Author(s):  
Laura V. Tsu ◽  
Kacey Carroll ◽  
Katee Kindler ◽  
Nicole Early
Keyword(s):  
Older People ◽  
Data Extraction ◽  
Adult Population ◽  
The Elderly ◽  
Research Review ◽  
Original Research ◽  
Older Individuals ◽  
Pcsk9 Inhibitors ◽  
Pharmacological Management ◽  
Common Chronic Disease

OBJECTIVE: To provide an up-to-date review of current hyperlipidemia guidelines and discuss pharmacotherapeutic management of hyperlipidemia in older individuals. DATA SOURCES: A PubMed search of articles published through October 2020 was performed using a combination of the following words: older adults, hyperlipidemia, statin, ezetimibe, fibrate, fish oil, niacin, bile acid sequestrant, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor. STUDY SELECTION/DATA EXTRACTION: Relevant original research, review articles, and guidelines were assessed for the management of hyperlipidemia in the older individuals. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results. DATA SYNTHESIS: Hyperlipidemia is a common chronic disease state in the elderly population, though there is limited evidence for clinical outcomes in older people when compared withwith the general adult population. Statins have the most evidence for primary and secondary prevention of cardiovascular disease in older people, though ezetimibe and PCSK9 inhibitors have a role as add-on or monotherapy in patients who do not tolerate statins. CONCLUSION: Optimal management of hyperlipidemia in older people is important in order to avoid further complications and improve outcomes. Pharmacists can help improve management in the elderly by incorporating up-to-date evidence from guidelines and providing medication education specifically for this population.

Abstract WMP57: Declining Blood Pressure is Associated with Subcortical Microinfarcts in Older Adults

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mekala R Raman ◽  
Jonathan Graff-Radford ◽  
Scott A Przybelski ◽  
Timothy G Lesnick ◽  
Michelle M Mielke ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Elderly Population ◽  
Adult Population ◽  
Blood Pressure Measurement ◽  
The Elderly ◽  
Pressure Measurements ◽  
Autopsy Study ◽  
Cross Sectional ◽  
Blood Pressures

Hypertension is highly prevalent in the elderly population and microinfarcts are the most common vascular brain pathology identified in older adults at autopsy. We investigated the associations between systolic and diastolic blood pressures measured antemortem and the presence of microinfarcts at autopsy. Study subjects (n=302; age range=71-95) were participants in the population-based Mayo Clinic Study of Aging autopsy study, who had blood pressure measurements recorded during life. We investigated both cross-sectional systolic and diastolic blood pressure measurements at the baseline visit and the change in blood pressure (slope). Presence and location (subcortical or cortical) of chronic microinfarcts was abstracted from the autopsy reports. Of the 302 study subjects, 47 (16%) had cerebral microinfarcts, and, of those, 18 (38%) had subcortical microinfarcts and 29 (62%) had only cortical microinfarcts. The baseline blood pressures were not different between subjects with no microinfarcts, subcortical microinfarcts, and only cortical microinfarcts. In a logistic regression model including time between last blood pressure measurement and death, a greater decline in systolic [OR= 1.06 (1.01, 1.11); p=0.02]) and greater decline in diastolic [OR= 1.11 (1.02, 1.20); p=0.01] blood pressures were predictors of the presence of subcortical microinfarcts at autopsy. However, these variables were not associated with the presence of cortical microinfarcts. In conclusion, microinfarcts are common in the older adult population, and most of them are located in the cortex. A greater decline in both systolic and diastolic blood pressures and their association with subcortical microinfarcts, but not with cortical microinfarcts, may have implications for aggressive lowering of blood pressure in the elderly population.

Aspirin Use for Primary Prevention of Cardiovascular Disease in Older Patients: A Review of Clinical Guidelines and Updated Evidence

2019 ◽  
Vol 34 (9) ◽  
pp. 580-594
Author(s):  
Jelena Lewis ◽  
Laressa Bethishou ◽  
Laura V. Tsu
Keyword(s):  
Older Adults ◽  
Primary Prevention ◽  
Older Patients ◽  
Data Extraction ◽  
The Elderly ◽  
Study Selection ◽  
Pubmed Search ◽  
Cv Disease ◽  
Meta Analyses

OBJECTIVE: To provide an up-to-date review of current guidelines, previous trials, and new trials regarding aspirin use in primary prevention of cardiovascular (CV) disease in the elderly population. DATA SOURCES: A PubMed search of articles published through April 2019 was performed using a combination of the following words: aspirin, bleeding, cardiovascular, elderly, hemorrhage, myocardial infarction, primary prevention, stroke. STUDY SELECTION/DATA EXTRACTION: Relevant randomized controlled trials, meta-analyses, and guidelines were assessed for the use of aspirin in primary prevention of CV disease in older patients. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results. DATA SYNTHESIS: The role of aspirin for primary prevention of CV disease in older adults is not well defined. As a result, the guideline recommendations for the use of aspirin in this setting are inconsistent. In 2018, the ARRIVE, ASCEND, and ASPREE studies were published. These studies tried to address some of the inconsistencies regarding the use of aspirin in primary prevention of CV disease. This article reviews the current recommendations along with previous and recent studies for aspirin use for primary prevention in older adults. CONCLUSION: The role of aspirin for primary prevention of CV disease in older adults should be individualized based on patient's risk factors, including risk of CV disease and likelihood of bleeding. Updated evidence provides more guidance regarding which patient populations will benefit from therapy.

Non-pharmacological methods in the treatment of resistant hypertension

Folia Medica ◽  
2012 ◽  
Vol 54 (2) ◽  
pp. 5-12 ◽  
Author(s):  
Kostadin N. Kichukov ◽  
Hristo V. Dimitrov ◽  
Lora K. Nikolova ◽  
Ivo S. Petrov ◽  
Maria P. Tokmakova
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
Antihypertensive Drugs ◽  
Adult Population ◽  
Clinical Problem ◽  
Renal Sympathetic Denervation ◽  
Great Promise ◽  
Long Term Effects ◽  
Blood Pressure Targets

ABSTRACT INTRODUCTION: Arterial hypertension is the most common chronic cardiovascular disease affecting about 25% of the adult population. Meta-analyses have demonstrated a linear relationship between blood pressure and the risk of cardiovascular events. Resistant hypertension defined as failure to reach blood pressure targets despite treatment with three antihypertensive drugs including a diuretic represents a serious clinical problem. It has been estimated that it affects between 8.9% and 12.8% of all treated hypertensive subjects. In resistant hypertension the optimal blood pressure is illusive despite very well tailored therapy. OBJECTIVE: Management of resistant hypertension is exactly the fi eld where blood pressurecontrolling non-pharmacological methods fi t best. The present article aims at throwing light on these methods’ principles of action, on who the target patient groups are and the respective results. Two methods are especially reviewed here: the carotid barorefl ex stimulation and the transcatheter renal sympathetic denervation. Current results from the use of renal denervation suggest stable effi ciency of the method, the results becoming signifi cant 6 months after the procedure is applied and sustained for two years in the follow-up. As much as 90% of the treated patients respond to the procedure. The transcatheter renal denervation is associated with only 2.61% of procedural complications. The barorefl ex carotid stimulation, too, is known to produce a stable effect on blood pressure: the effect become obvious at 12 months in 88% of the treated subjects. The neurologic complications associated with the procedure are reported to occur in 4.4% of cases. CONCLUSION: The present review article clearly demonstrates that non-pharmacological methods for treatment of resistant hypertension show great promise despite some open questions concerning their long term effects and procedural safety.

scholarly journals Systematic Review of Guidelines on Antihypertensive Treatment in Older Adults: SPRINTing to More Heterogeneity?

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 212-213
Author(s):  
Jonathan Bogaerts ◽  
Leonie von Ballmoos ◽  
Wilco Achterberg ◽  
Jacobijn Gussekloo ◽  
Sven Streit ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Antihypertensive Treatment ◽  
Oldest Old ◽  
Middle Aged ◽  
Frail Older Adults ◽  
Blood Pressure Targets ◽  
All Cause Mortality ◽  
Guideline Quality

Abstract Clinical trials have demonstrated that antihypertensive treatment (AHT) in older adults is beneficial. Longitudinal studies, in contrast, have shown that low blood pressure is associated with higher all-cause mortality, especially in frail older adults. Despite the high quality of the available evidence, its translation into clinical guidance for the heterogeneous older population is challenging. To give a systematic overview of blood pressure targets for older adults recommended in clinical guidelines, we searched PubMed, Embase, Emcare, and five guideline databases. We selected guidelines with numerical thresholds for the initiation or the goal of non-disease-specific AHT (January 2008-October 2019). Guidelines with advices concerning AHT in older adults were analyzed. We appraised the guideline quality with the AGREEII-instrument. Of the 44 guidelines containing a numerical threshold for the initiation or the goal of AHT, 33 (75%) provided recommendations concerning AHT for older adults. Nineteen advised a higher target of systolic blood pressure (SBP) for older adults in comparison with the middle-aged population and 3 more recent advised a lower target. Over half (19/33) recommended to treat hypertension in the oldest old to a SBP &lt;150 mmHg, while others advised intensive treatment to targets &lt;120 mmHg. Although many guidelines mentioned frailty, only three gave specific thresholds and targets for frail older adults. The quality of the guidelines was not related with the recommended targets. Targets of AHT in older adults in international guidelines range from less strict to more intensive in comparison with the middle-aged and are set on chronological rather than biological age.

Aspirin Use for Primary Prevention of Cardiovascular Disease in Older Patients: A Review of Clinical Guidelines and Updated Evidence

2019 ◽  
Vol 34 (9) ◽  
pp. 580-594
Author(s):  
Jelena Lewis ◽  
Laressa Bethishou ◽  
Laura V. Tsu
Keyword(s):  
Older Adults ◽  
Primary Prevention ◽  
Older Patients ◽  
Data Extraction ◽  
The Elderly ◽  
Study Selection ◽  
Pubmed Search ◽  
Cv Disease ◽  
Meta Analyses

OBJECTIVE: To provide an up-to-date review of current guidelines, previous trials, and new trials regarding aspirin use in primary prevention of cardiovascular (CV) disease in the elderly population. DATA SOURCES: A PubMed search of articles published through April 2019 was performed using a combination of the following words: aspirin, bleeding, cardiovascular, elderly, hemorrhage, myocardial infarction, primary prevention, stroke. STUDY SELECTION/DATA EXTRACTION: Relevant randomized controlled trials, meta-analyses, and guidelines were assessed for the use of aspirin in primary prevention of CV disease in older patients. References from the above literature were also evaluated. Articles were selected for inclusion based on relevance to the topic, detailed methods, and complete results. DATA SYNTHESIS: The role of aspirin for primary prevention of CV disease in older adults is not well defined. As a result, the guideline recommendations for the use of aspirin in this setting are inconsistent. In 2018, the ARRIVE, ASCEND, and ASPREE studies were published. These studies tried to address some of the inconsistencies regarding the use of aspirin in primary prevention of CV disease. This article reviews the current recommendations along with previous and recent studies for aspirin use for primary prevention in older adults. CONCLUSION: The role of aspirin for primary prevention of CV disease in older adults should be individualized based on patient's risk factors, including risk of CV disease and likelihood of bleeding. Updated evidence provides more guidance regarding which patient populations will benefit from therapy.

scholarly journals Intervention elements to reduce inappropriate prescribing for older adults with multimorbidity receiving outpatient care: a scoping review

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039543
Author(s):  
Jia Qi Lee ◽  
Kate Ying ◽  
Penny Lun ◽  
Keng Teng Tan ◽  
Wendy Ang ◽  
...  
Keyword(s):  
Older Adults ◽  
Scoping Review ◽  
Data Extraction ◽  
Adult Population ◽  
Grey Literature ◽  
Inappropriate Prescribing ◽  
Complex Interventions ◽  
Final Analysis ◽  
Outpatient Setting ◽  
Cochrane Library

ObjectivePolypharmacy occurs in approximately 30% of older adults aged 65 years or more, particularly among those with multimorbidity. With polypharmacy, there is an associated risk of potentially inappropriate prescribing (PIP). The aims of this scoping review were to (1) identify the intervention elements that have been adopted to reduce PIP in the outpatient setting and (2) determine the behaviour change wheel (BCW) intervention functions performed by each of the identified intervention elements.DesignScoping reviewData sourcesPubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Web of Science and Cochrane Library databases, grey literature sources, six key geriatrics journals and the reference lists of review papers.Study selectionAll studies reporting an intervention or strategy that addressed PIP in the older adult population (age ≥65) with multimorbidity in the outpatient setting and in which the primary prescriber is the physician.Data extractionData extracted from the included studies can be broadly categorised into (1) publication details, (2) intervention details and (3) results. This was followed by data synthesis and analysis based on the BCW framework.ResultsOf 8195 studies yielded, 80 studies were included in the final analysis and 14 intervention elements were identified. An average of two to three elements were adopted in each intervention. The three most frequently adopted intervention elements were medication review (70%), training (26.3%) and tool/instrument(s) (22.5%). Among medication reviews, 70% involved pharmacists. The 14 intervention elements were mapped onto five intervention functions: ‘education’, ‘persuasion’, ‘training’, ‘environmental restructuring’ and ‘enablement’.ConclusionPIP is a multifaceted problem that involves multiple stakeholders. As such, interventions that address PIP require multiple elements to target the behaviour of the various stakeholders. The intervention elements and their corresponding functions identified in this scoping review will serve to inform the design of complex interventions that aim to reduce PIP.

scholarly journals C-09 Diastolic Blood Pressure and Executive Function in Healthy Older Adults

2019 ◽  
Vol 34 (6) ◽  
pp. 1036-1036
Author(s):  
B Staley Shumaker ◽  
G Wei Qi ◽  
S Amano ◽  
A Nolty ◽  
M Harrington
Keyword(s):  
Blood Pressure ◽  
Older Adults ◽  
Executive Functioning ◽  
Diastolic Blood Pressure ◽  
Sex Education ◽  
Adult Population ◽  
Stroop Interference ◽  
Healthy Older Adults ◽  
High Functioning ◽  
Z Scores

Abstract Objective Our aim was to investigate the effect of elevated diastolic blood pressure (DBP) within normal blood pressure range (NBPR) on an executive functioning task (Stroop C) in a cognitively healthy, high functioning, older adult population. Method Archival data at Huntington Medical Research Institutes provided 35 cognitively healthy, high functioning adults from 63 to 89 years of age (M = 76, SD = 7.0). The majority were female and Caucasian, and had college or higher degrees. A general linear model (GLM) regression analysis was performed to determine if the Stroop C Interference z score would be predicted by DBP NBPR when controlling for age, sex, education level, and ApoE4 genotype. Results The regression model for DBP NBPR on Stroop Interference z scores was significant, F(5, 29) = 1.56, p < .05, with increased DBP NBPR associated with decreased Stroop Interference z scores (slower completion time). Conclusions Increased DBP NBPR was negatively associated with executive functioning as indicated by Stroop C Interference performance, such that individuals with slower completion times had elevated DBP NBPR measurements. These results suggest that increased DBP NBPR may play a role in the reduction of executive functioning performance in cognitively healthy older adults and are consistent with prior findings identifying increased DBP as a risk factor for neurodegeneration (den Heijer et al., 2005; Kennelly et al., 2009). The current study highlights the need for increased attention to the role of DBP in neurodegeneration.

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