Hypertension in the Elderly

As the population ages, the prevalence of hypertension is increasing worldwide. Hypertension is well recognised as a significant cardiovascular risk factor increasing the likelihood of major adverse cardiovascular events (MACE). In older people, it is also recognised to increase the risk of renal as well as cognitive dysfunction. Consequently, blood pressure (BP) control is associated with reduced risk of MACE as well as inhibiting the progression of chronic kidney disease (CKD) with more recent guidelines suggesting lower BP targets (<130/80 mmHg) could further enhance cardiovascular protection. The relationship between BP control and the preservation of cognitive function, however, remains unclear. Moreover, this lower target may not be appropriate for older patients, due to the heterogeneity of functional status and burden of comorbid health status within this population. The increased prevalence of frailty, falls, autonomic dysfunction, dementia, polypharmacy and the predominance of isolated systolic hypertension in older patients needs to be carefully considered when deciding to treat hypertension. More intensive BP control, if well tolerated, may be appropriate in functionally able older persons whilst relaxed BP targets are reasonable in individuals with physical and/or cognitive decline. Individualised BP targets in older people are imperative to maintain quality of life. This chapter reviews the management challenges of hypertension in this rapidly growing and diverse elderly population.