Should age impact on how we manage hypertension?
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.
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