Blood pressure targets, medication consideration and unique concerns in elderly hypertension IV: Focus on frailty, orthostatic hypotension, and resistant hypertension

Po-Sheng Wu; Chia-Ter Chao; Chien-Hao Hsiao; Chiu-Fen Yang; Ying-Hsiang Lee; Hung-Ju Lin; Chih-Fan Yeh; Long-Teng Lee; Kuo-Chin Huang; Meng-Chih Lee; Cheng-Kuo Huang; Yen-Hung Lin; Michael Yu-Chih Chen; Ding-Cheng Chan

doi:10.1016/j.jfma.2024.09.022

Blood pressure targets, medication consideration and unique concerns in elderly hypertension IV: Focus on frailty, orthostatic hypotension, and resistant hypertension

J Formos Med Assoc. 2024 Oct 5:S0929-6646(24)00442-X. doi: 10.1016/j.jfma.2024.09.022. Online ahead of print.

Authors

Po-Sheng Wu¹, Chia-Ter Chao², Chien-Hao Hsiao³, Chiu-Fen Yang⁴, Ying-Hsiang Lee⁵, Hung-Ju Lin⁶, Chih-Fan Yeh⁶, Long-Teng Lee⁷, Kuo-Chin Huang⁷, Meng-Chih Lee⁸, Cheng-Kuo Huang⁹, Yen-Hung Lin⁶, Michael Yu-Chih Chen¹⁰, Ding-Cheng Chan¹¹

Affiliations

¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.
² Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan; Graduate Institute of Toxicology, National Taiwan University College of Medicine, Taipei, Taiwan.
³ Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
⁴ Department of Cardiology, Cardiovascular Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
⁵ Department of Medicine, Mackay Medical College, Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital, New Taipei City, Taiwan.
⁶ Division of Cardiology, Department of Internal Medicine and Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
⁷ Department of Family Medicine, National Taiwan University Hospital & National Taiwan University, Taipei, Taiwan.
⁸ Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung City, Taiwan; Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan; College of Management, Chaoyang University of Technology, Taichung, Taiwan; Study Group of Integrated Health and Social Care Project, Ministry of Health and Welfare, Taichung, Taiwan.
⁹ Taiwan Association of Family Medicine, Taipei, Taiwan; Dr. Cheng-Kuo Huang Clinic, Keelung, Taiwan.
¹⁰ Division of Cardiology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan.
¹¹ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: [email protected].

PMID: 39370367
DOI: 10.1016/j.jfma.2024.09.022

Abstract

Hypertension increases the risk of cardiovascular disease in the elderly. Although treating hypertension can reduce the risk of cardiovascular disease and its related mortality, it is also challenging because these patients could have frailty, orthostatic hypotension (OH) and resistant hypertension (RHTN), which makes them more susceptible to treatment-related adverse events. Identifying such patients and tailoring the choice of drugs and blood pressure targets is crucial to balance the harms and benefits. The Clinical Frailty Scale is recommended to assess elderly patients with hypertension and frailty. For very frail patients, unnecessary medications should be deprescribed to avoid adverse events. Hypertension and OH frequently co-occur in the elderly, and recognizing and managing OH is essential to prevent falls and adverse events. The management of blood pressure in elderly patients with frailty, OH, and RHTN is complex, requiring the patients, their family and caregivers to be involved in decision-making to ensure that treatment plans are well-informed and aligned with the patient's needs.

Keywords: Assessment; Frailty; Geriatric; Hypertension; Intervention; Orthostatic hypotension; Resistant hypertension.

Publication types

Review