Journal of Medicine and Life Science

  • 제19권3호
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  • Pages.79-89
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  • 2022
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  • 1738-1010(pISSN)
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  • 2671-4922(eISSN)
제주대학교 의과학연구소 (Institute for Medical Science)
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노인 고혈압의 치료

Treatment of hypertension in elderly

  • 주승재 (제주대학교병원 심장내과) ;
  • 김동수 (인제대학교해운대백병원 심장내과)
  • Seung Jae Joo (Division of Cardiology, Department of Internal Medicine, Jeju National University Hospital) ;
  • Dong-Soo Kim (Division of Cardiology, Department of Internal Medicine, Inje University Haeundae Paik Hospital)
  • 투고 : 2022.08.06
  • 심사 : 2022.10.20
  • 발행 : 2022.12.31
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초록

Whereas systolic blood pressure (SBP) continuously rises with age, diastolic blood pressure (DBP) gradually decreases after the age of 55 years. Therefore, hypertension in the elderly shows the pattern of isolated systolic hypertension. There is evidence on the benefits of controlling blood pressure (BP) in elderly patients with hypertension. The BP lowering effect has also been demonstrated in patients over 80 years of age with hypertension. The BP threshold for the initiation of antihypertensive drug treatment for older adults with hypertension is gradually decreasing. The antihypertensive treatment is recommended if, despite therapeutic lifestyle modifications, SBP ≥140 mmHg or DBP ≥90 mmHg in those aged 65-79 years old, and SBP ≥140-160 mmHg or DBP ≥90 mmHg in those aged ≥80 years old. Although there is no consensus on the target BP for older adults with hypertension, a target SBP of <130-140 mmHg and DBP of <80-90 mmHg are recommended. In older adults over 80 years of age with hypertension, the target SBP is <140-150 mmHg. When the dose of antihypertensive drugs is increased to reach the target SBP, DBP may decrease to less than 70 mmHg, but it should not be <60 mmHg. Thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, or angiotensin receptor blockers can be selected as the first-line drug for older adults with hypertension. Beta-blockers may be selected in case of compelling indications.

키워드

과제정보

이 논문은 2022학년도 제주대학교 교육·연구 및 학생지도비 지원에 의해서 연구되었다.

참고문헌

  1. Kim HC, Lee H, Lee HH, Seo E, Kim E, Han J, et al. Korea hypertension fact sheet 2021: analysis of nationwide population-based data with special focus on hypertension in women. Clin Hypertens 2022;28:1.
  2. Ikonomidis I, Aboyans V, Blacher J, Brodmann M, Brutsaert DL, Chirinos JA, et al. The role of ventricular-arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association. Eur J Heart Fail 2019;21:402-24.
  3. Laurent S, Boutouyrie P. Arterial Stiffness and hypertension in the elderly. Front Cardiovasc Med 2020;7:544302.
  4. Lee JG, Joo SJ. Arterial stiffness and cardiovascular risk. Korean J Intern Med 2019;34:504-6.
  5. Vlachopoulos C, Xaplanteris P, Aboyans V, Brodmann M, Cifkova R, Cosentino F, et al. The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation: Endorsed by the Association for Research into Arterial Structure and Physiology (ARTERY) Society. Atherosclerosis 2015;241:507-32.
  6. Izzo JL Jr, Levy D, Black HR. Clinical advisory statement. Importance of systolic blood pressure in older Americans. Hypertension 2000;35:1021-4.
  7. Staessen JA, Gasowski J, Wang JG, Thijs L, Den Hond E, Boissel JP, et al. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet 2000;355:865-72.
  8. Blood Pressure Lowering Treatment Trialists' Collaboration, Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 2008;336:1121-3.
  9. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358:1887-98.
  10. Bejan-Angoulvant T, Saadatian-Elahi M, Wright JM, Schron EB, Lindholm LH, Fagard R, et al. Treatment of hypertension in patients 80 years and older: the lower the better? A meta-analysis of randomized controlled trials. J Hypertens 2010;28:1366-72.
  11. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, et al. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens 2009;27:2121-58.
  12. JATOS Study Group. Principal results of the Japanese trial to assess optimal systolic blood pressure in elderly hypertensive patients (JATOS). Hypertens Res 2008;31:2115-27.
  13. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281-357.
  14. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-20.
  15. ACCORD Study Group, Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med 2010;362:1575-85.
  16. SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015;373:2103-16.
  17. Williamson JD, Supiano MA, Applegate WB, Berlowitz DR, Campbell RC, Chertow GM, et al. Intensive vs standard blood pressure control and cardiovascular disease outcomes in adults aged ≥75 years: a randomized clinical trial. JAMA 2016;315:2673-82.
  18. Pajewski NM, Berlowitz DR, Bress AP, Callahan KE, Cheung AK, Fine LJ, et al. Intensive vs standard blood pressure control in adults 80 years or older: a secondary analysis of the systolic blood pressure intervention trial. J Am Geriatr Soc 2020;68:496-504.
  19. Lee HY, Shin J, Kim GH, Park S, Ihm SH, Kim HC, et al. 2018 Korean Society of Hypertension guidelines for the management of hypertension: part II-diagnosis and treatment of hypertension. Clin Hypertens 2019;25:20.
  20. Zhang WL, Cai J. STEP to blood pressure management of elderly hypertension: evidence from Asia. Hypertens Res 2022;45:576-82.
  21. Lonn EM, Bosch J, Lopez-Jaramillo P, Zhu J, Liu L, Pais P, et al. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:2009-20.
  22. Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Hypertension 2018;71:e13-115.
  23. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J 2018;39:3021-104.
  24. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Back M, et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021;42:3227-337.
  25. Hua Q, Fan L, Li J; Joint Committee for Guideline Revision. 2019 Chinese guideline for the management of hypertension in the elderly. J Geriatr Cardiol 2019;16:67-99.
  26. Umemura S, Arima H, Arima S, Asayama K, Dohi Y, Hirooka Y, et al. The Japanese Society of Hypertension guidelines for the management of hypertension (JSH 2019). Hypertens Res 2019;42:1235-481.
  27. National Institute for Health and Care Excellence (NICE). Hypertension in adults: diagnosis and management [Internet]. London: NICE; c2019 [cited 2022 Aug 1]. Available from: https://www.nice.org.uk/guidance/ng136
  28. Zhang W, Zhang S, Deng Y, Wu S, Ren J, Sun G, et al. Trial of intensive blood-pressure control in older patients with hypertension. N Engl J Med 2021;385:1268-79.
  29. The Korean Society of Hypertension. The 2022 Korean Society of Hypertension guideline for the management of hypertension: focused update of the 2018 KSH guideline [Internet]. Seoul: The Korean Society of Hypertension; c2022 [cited 2022 Nov 4]. Available from: http://www.koreanhypertension.org/reference/guide?mode=read&idno=10081
  30. Douros A, Tolle M, Ebert N, Gaedeke J, Huscher D, Kreutz R, et al. Control of blood pressure and risk of mortality in a cohort of older adults: the Berlin Initiative Study. Eur Heart J 2019;40:2021-8.
  31. Rivasi G, TortuV, D'Andria MF, Turrin G, Ceolin L, Rafanelli M, et al. Hypertension management in frail older adults: a gap in evidence. J Hypertens 2021;39:400-7.
  32. Shin J, Kim KI. A clinical algorithm to determine target blood pressure in the elderly: evidence and limitations from a clinical perspective. Clin Hypertens 2022;28:17.
  33. Messerli FH, Panjrath GS. The J-curve between blood pressure and coronary artery disease or essential hypertension: exactly how essential? J Am Coll Cardiol 2009;54:1827-34.
  34. Vidal-Petiot E, Ford I, Greenlaw N, Ferrari R, Fox KM, Tardif JC, et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet 2016;388:2142-52.
  35. Bohm M, Schumacher H, Teo KK, Lonn EM, Mahfoud F, Mann JFE, et al. Cardiovascular outcomes and achieved blood pressure in patients with and without diabetes at high cardiovascular risk. Eur Heart J 2019;40:2032-43.
  36. VokoZ, Bots ML, Hofman A, Koudstaal PJ, Witteman JC, Breteler MM. J-shaped relation between blood pressure and stroke in treated hypertensives. Hypertension 1999;34:1181-5.
  37. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.
  38. Beddhu S, Chertow GM, Cheung AK, Cushman WC, Rahman M, Greene T, et al. Influence of baseline diastolic blood pressure on effects of intensive compared with standard blood pressure control. Circulation 2018;137:134-43.
  39. Li J, Somers VK, Gao X, Chen Z, Ju J, Lin Q, et al. Evaluation of optimal diastolic blood pressure range among adults with treated systolic blood pressure less than 130 mm Hg. JAMA Netw Open 2021;4:e2037554.
  40. Gaffney B, Jacobsen AP, Pallippattu AW, Leahy N, McEvoy JW. The diastolic blood pressure J-Curve in hypertension management: links and risk for cardiovascular disease. Integr Blood Press Control 2021;14:179-87.
  41. Laragh J. Laragh's lessons in pathophysiology and clinical pearls for treating hypertension. Am J Hypertens 2001;14:491-503.
  42. Kjeldsen SE, Dahlof B, Devereux RB, Julius S, Aurup P, Edelman J, et al. Effects of losartan on cardiovascular morbidity and mortality in patients with isolated systolic hypertension and left ventricular hypertrophy: a Losartan Intervention for Endpoint Reduction (LIFE) substudy. JAMA 2002;288:1491-8.
  43. Kizer JR, Dahlof B, Kjeldsen SE, Julius S, Beevers G, de Faire U, et al. Stroke reduction in hypertensive adults with cardiac hypertrophy randomized to losartan versus atenolol: the Losartan Intervention For Endpoint reduction in hypertension study. Hypertension 2005;45:46-52.
  44. Dahlof B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005;366:895-906.
  45. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007;25:1105-87.
  46. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009;338:b1665.