Hypertension

Hypertension is very common in older adults and causes significant morbidity and mortality. Treatment is very effective at reducing stroke, cardiac events, and mortality, even in the very old. Hypertension is defined as a systolic blood pressure > 130 mmHg or a diastolic blood pressure > 80 mmHg. Due to changes in physiology, comorbid conditions, increased susceptibility to side effects, and socioeconomic factors, blood pressure goals and treatments must be individualized for each older adult. The blood pressure goal in robust patients is systolic blood pressure < 130 mmHg. Nursing home residents and patients with advanced frailty or advanced cognitive decline likely need higher goals. Nonpharmacologic therapy should be implemented in all patients. First-line antihypertensive agents are angiotensin-converting enzyme inhibitors, non-dihydropyridine calcium channel blockers, thiazide diuretics, and angiotensin II receptor blockers. Comorbid conditions may influence choice of agents. Therapy requires close monitoring for potentially serious side effects, including electrolyte abnormalities, renal function, and orthostatic hypotension. Deprescribing should regularly be considered as cognition declines, frailty increases, or there are serious side effects from treatment. Involving caregivers in the education and management of hypertension is often essential due to frailty and/or cognitive decline. Use of an interprofessional team and telehealth for monitoring can be very helpful in the longitudinal care of older adults with hypertension.