Elderly Patient with Hypertension in General Practice: Clinical Features and Antihypertensive Therapy

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Viacheslav Zhdan
Yevdokiia Kitura
Maryna Babanina
Oksana Kitura
Maksym Tkachenko

Abstract

The prevalence of arterial hypertension (AH) increases with age: among people over 60 years old this index is more than 2 times higher in the general population, 2/3 of people over 65 years old suffer from hypertension. Among patients 65–89 years old with hypertension, 2/3 patients have isolated systolic hypertension (ISAG).


Features of hypertension in the elderly patients are: lability of blood pressure (BP), increasing frequency of pseudohypertension, high frequency of «white coat hypertension», decreased sensitivity of pressor factors for antihypertensive drugs, high frequency of resistant to treatment of hypertension.


The new recommendations of the European Society of Cardiology for the diagnosis and treatment of hypertension emphasize 2 groups of elderly patients: 65–79 years old and ≥80 years old, which described the epidemiological features, the prevalence of risk factors for cardiovascular events, blood pressure levels for antihypertensive therapy and target blood pressure, and the recommended principles of drug therapy that are different from young and middle-aged patients. For most patients, fixed combinations are indicated as starting AGT, but monotherapy is recommended for the treatment of hypertension in very elderly patients (over 80 years old) and elderly patients over 65 years old with senile asthenia. The decreasing of blood pressure should be gradual, taking into consideration the increased risk of orthostatic reactions at this age.


European and American experts recommend os first-line drugs low doses of thiazide diuretics and calcium channel antagonists (mainly dihydropyridine), which are especially indicated in isolated systolic arterial hypertension to effectively reduce the frequency of cardiovascular complications in the treatment of elderly patients with hypertension.

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Section
Cardiology
Author Biographies

Viacheslav Zhdan, Medical Stomatological Academy of Ukraine

Viacheslav M. Zhdan,

Department of Family Medicine and Therapy

Yevdokiia Kitura, Medical Stomatological Academy of Ukraine

Yevdokiia M. Kitura,

Department of Family Medicine and Therapy

Maryna Babanina, Medical Stomatological Academy of Ukraine

Maryna Yu. Babanina,

Head of Department of Family Medicine and Therapy

Oksana Kitura, Medical Stomatological Academy of Ukraine

Oksana Ye. Kitura,

Department of Internal Diseases and Emergency Medicine with Cutaneous and Venereal Diseases

Maksym Tkachenko, Medical Stomatological Academy of Ukraine

Maksym V. Tkachenko,

Department of Family Medicine and Therapy

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