Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?

Edelgard Anna Kaiser,1 Ulrich Lotze,2 Hans Hendrik Schäfer1,31Roche Diagnostics International AG, Rotkreuz, Switzerland; 2Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Bad Frankenhausen, Germany; 3Institute of Anatomy II, University Hospital Jena, Friedrich-Sc...

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Autores principales:	Kaiser EA, Lotze U, Schäfer HH
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2014
Materias:	drug antihypertensive therapy elderly very elderly guidelines evidence Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/0928767248364d25b4c3f0eb398ee004
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spelling	oai:doaj.org-article:0928767248364d25b4c3f0eb398ee0042021-12-02T04:13:22ZIncreasing complexity: which drug class to choose for treatment of hypertension in the elderly?1178-1998https://doaj.org/article/0928767248364d25b4c3f0eb398ee0042014-03-01T00:00:00Zhttps://www.dovepress.com/increasing-complexity-which-drug-class-to-choose-for-treatment-of-hype-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Edelgard Anna Kaiser,1 Ulrich Lotze,2 Hans Hendrik Schäfer1,31Roche Diagnostics International AG, Rotkreuz, Switzerland; 2Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Bad Frankenhausen, Germany; 3Institute of Anatomy II, University Hospital Jena, Friedrich-Schiller University, Jena, GermanyAbstract: Treatment of hypertension in the elderly is expected to become more complex in the coming decades. Based on the current landscape of clinical trials, guideline recommendations remain inconclusive. The present review discusses the latest evidence derived from studies available in 2013 and investigates optimal blood pressure (BP) and preferred treatment substances. Three common archetypes are discussed that hamper the treatment of hypertension in the very elderly. In addition, this paper presents the current recommendations of the NICE 2011, JNC7 2013-update, ESH/ESC 2013, CHEP 2013, JNC8 and ASH/ISH guidelines for elderly patients. Advantages of the six main substance classes, namely diuretics, beta-blockers (BBs), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and direct renin inhibitors (DRIs) are discussed. Medical and economic implications of drug administration in the very elderly are presented. Avoidance of treatment-related adverse effects has become increasingly relevant. Current substance classes are equally effective, with similar effects on cardiovascular outcomes. Selection of substances should therefore also be based on collateral advantages of drugs that extend beyond BP reduction. The combination of ACEIs and diuretics appears to be favorable in managing systolic/diastolic hypertension. Diuretics are a preferred and cheap combination drug, and the combination with CCBs is recommended for patients with isolated systolic hypertension. ACEIs and CCBs are favorable for patients with dementia, while CCBs and ARBs imply substantial cost savings due to high adherence.Keywords: drug, antihypertensive therapy, elderly, very elderly, guidelines, evidenceKaiser EALotze USchäfer HHDove Medical Pressarticledrugantihypertensive therapyelderlyvery elderlyguidelinesevidenceGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 9, Pp 459-475 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	drug antihypertensive therapy elderly very elderly guidelines evidence Geriatrics RC952-954.6
spellingShingle	drug antihypertensive therapy elderly very elderly guidelines evidence Geriatrics RC952-954.6 Kaiser EA Lotze U Schäfer HH Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?
description	Edelgard Anna Kaiser,1 Ulrich Lotze,2 Hans Hendrik Schäfer1,31Roche Diagnostics International AG, Rotkreuz, Switzerland; 2Department of Internal Medicine, DRK-Manniske-Krankenhaus Bad Frankenhausen, Bad Frankenhausen, Germany; 3Institute of Anatomy II, University Hospital Jena, Friedrich-Schiller University, Jena, GermanyAbstract: Treatment of hypertension in the elderly is expected to become more complex in the coming decades. Based on the current landscape of clinical trials, guideline recommendations remain inconclusive. The present review discusses the latest evidence derived from studies available in 2013 and investigates optimal blood pressure (BP) and preferred treatment substances. Three common archetypes are discussed that hamper the treatment of hypertension in the very elderly. In addition, this paper presents the current recommendations of the NICE 2011, JNC7 2013-update, ESH/ESC 2013, CHEP 2013, JNC8 and ASH/ISH guidelines for elderly patients. Advantages of the six main substance classes, namely diuretics, beta-blockers (BBs), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and direct renin inhibitors (DRIs) are discussed. Medical and economic implications of drug administration in the very elderly are presented. Avoidance of treatment-related adverse effects has become increasingly relevant. Current substance classes are equally effective, with similar effects on cardiovascular outcomes. Selection of substances should therefore also be based on collateral advantages of drugs that extend beyond BP reduction. The combination of ACEIs and diuretics appears to be favorable in managing systolic/diastolic hypertension. Diuretics are a preferred and cheap combination drug, and the combination with CCBs is recommended for patients with isolated systolic hypertension. ACEIs and CCBs are favorable for patients with dementia, while CCBs and ARBs imply substantial cost savings due to high adherence.Keywords: drug, antihypertensive therapy, elderly, very elderly, guidelines, evidence
format	article
author	Kaiser EA Lotze U Schäfer HH
author_facet	Kaiser EA Lotze U Schäfer HH
author_sort	Kaiser EA
title	Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?
title_short	Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?
title_full	Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?
title_fullStr	Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?
title_full_unstemmed	Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?
title_sort	increasing complexity: which drug class to choose for treatment of hypertension in the elderly?
publisher	Dove Medical Press
publishDate	2014
url	https://doaj.org/article/0928767248364d25b4c3f0eb398ee004
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Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?

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