820
T
wo years after the publication of the 2013 guidelines for
the management of arterial hypertension of the European
Society of Hypertension (ESH) and the European Society of
Cardiology (ESC),
1
the ESH and the European Union Geriatric
Medicine Society have created a common working group to
examine the management of hypertensive subjects aged >80
years. The general term hypertension in the elderly is not suf-
ficiently accurate because it mixes younger old patients (60–70
years) with the oldest old. Our group believes that the man-
agement of hypertension in individuals aged ≥ 80 years should
be specifically addressed. Although arbitrary, this cutoff value
identifies a population that is expanding faster than any other
age group with a 50% increase of life expectancy during the
past 50 years
2,3
; furthermore, the incidence and prevalence of
comorbidities, frailty, and loss of autonomy greatly increases
after the age of 80 years
4
; finally, although there is limited evi-
dence on the management of hypertension in this age group,
the latest clinical studies indicate that in these patients, treat-
ment may not be the same as in patients in the lower age strata.
The aim of this Working Group was to discuss more in-
depth treatment aspects of hypertensive patients aged ≥80
years or older, with special focus on the difficulties and
uncertainties posed by very old frail individuals. We focused,
in particular, on the following points of the 2013 ESH/ESC
guidelines:
Benefits of treatment.
Blood pressure (BP) thresholds and targets.
The choice of treatment.
Benefits of Treatment
The 2013 ESH/ESC guidelines
1
reported the results of
the Hypertension in the Very Elderly Double Blind Trial
(HYVET). This showed that in hypertensive patients aged ≥80
years, the administration of the thiazide-like diuretic indap-
amide supplemented, if necessary, by the angiotensin-convert-
ing enzyme inhibitor perindopril led to a significant reduction
in the risk of m
2016衰弱老年人血压管理指南.pdf