From Clinical Trials to Bedside: the Use of Antihypertensives in Aged Individuals. Part 2: Approach to Treatment.

PURPOSE OF REVIEW: Use of antihypertensives in older adults can be complicated by the potential for undesired effects on comorbidities, adverse effects of the drugs, and overall medication burden. The purpose of this two-part review is to discuss contemporary issues encountered in the management of hypertension in aged individuals, with a particular focus on considerations for the individualization of treatment. In Part 2, we discuss the individualized approach to treating hypertension in the elderly. RECENT FINDINGS: Achieving lower blood pressure goals in older adults has the potential to increase risks for complications such as hypotension and acute renal insufficiency, especially in those less healthy. Because elderly exhibit many different phenotypes, a one-size-fits-all approach to treatment goals and choice of antihypertensives is problematic. Many areas of uncertainty remain, including what the optimal goal blood pressure should be in frail or institutionalized elderly, whether there is an upper age limit for treatment initiation where benefits and risks overlap, and when de-escalation of antihypertensives should be considered. Hypertension is a major modifiable risk factor, and the benefits of treatment in lowering cardiovascular events are realized for most individuals, even at advanced ages. Areas of uncertainty in the management of hypertension in this group mandate a cautious, individualized approach to treatment which relies on careful assessment of biologic or phenotypic age, rather than chronologic age alone.