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Should age impact on how we manage hypertension?

Should age impact on how we manage hypertension?

09 Sep 2021

A familiar dilemma in the day of a clinical pharmacist…

NICE recommends ACE inhibitors are used first-line to management of hypertension in those <55y, and calcium channel blockers (CCBs) in those ≥55y (once diabetes and ethnicity are taken into account).

However, a UK cohort study showed that:

  • In those who were not black, not diabetic and <55y there was no significant difference in BP control between ACE inhibitors or CCBs at 12 months.
  • CCBs did seem to have greater BP-lowering effects in those over 75y.

What about BP targets in our frail patients?

A UK observational study showed that:

  • In those over 85y, raised blood pressure was not associated with increased mortality (even if SBP >180!).
  • In those aged 75–85y:
    • If moderately–severely frail, there was NO association between raised BP and mortality.
    • If mildly frail, raised blood pressure WAS associated with increased mortality.
    • Having too low a blood pressure was also harmful: in those ≥75y, BP <130/80 was associated with an increased risk of all-cause mortality.

What does this mean in practice?

Guidelines are written for populations, and if there is a good reason to deviate from them then we are free to do that (remember to document your reasoning!).

  • We can think more about comorbidities when choosing which drug to use; hypertension + proteinuria = consider ACE inhibitor, hypertension + CVA = consider CCB.
  • Don’t be afraid to adjust blood pressure targets people as become more frail.

Found this snippet useful? Red Whale runs one-day Clinical Pharmacist Update Courses, packed with updates like this, and has provided general update, cancer and MSK/chronic pain education (both face to face and online) to over 4000 pharmacists over the past five years through our longstanding relationship with CPPE.

 

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