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Jsou cílové hodnoty pro léčbu arteriální hypertenze odlišné ve středním a vyšším věku?
Co říkají klinické studie, guidelines a jaká jsou současná doporučení pro klinickou praxi.


Authors: Prof. MUDr. Eva Topinková, CSc.;  MUDr. Marie Berková, Ph.D.;  MUDr. Tomáš Richter
Authors‘ workplace: Geriatrická klinika 1. LF UK a VFN, Praha
Published in: Geriatrie a Gerontologie 2014, 3, č. 1: 12-17
Category: Review Article

Overview

Hypertension is the most common cardiovascular disease in old age, associated with increased risk of cardiovascular and cerebrovascular complications. There is no doubt that efficient treatment achieving target blood pressure values <140/80 mmHg in the 40s-50s age group significantly reduces the rates of negative outcomes such as strokes, cardiovascular events, overall and cardiovascular mortality. Much less evidence is available for treatment of older patients, 65 years older or for very old patients, aged 80 years and more. Some studies even suggest that with more aggressive treatment, with SBP levels of 135 mmHg and below, mortality not only does not decline but it is in fact increasing (J or U shape mortality curves). Lack of consistent evidence is reflected in current American, European and Czech guidelines, with differing target blood pressure values for seniors. In clinical practice the target values thus differ between individual clinicians. In the article we review results of studies published so far on efficacy of hypertension treatment and discuss recommendations for optimal hypertension control in seniors in daily practice.

Key words:
arterial hypertension – isolated systolic hypertension – old age – scientific evidence – target values


Sources

1. Ostchega Y, Dillon CF, Hughes JP, Carroll M, Yoon S: Trends in hypertension prevalence, awareness, treatment, and control in older US adults: data from the National Health and Nutrition Examination Survey 1988 to 2004. J Am Geriatr Soc 2007;55(7):1056–1065.

2. Burt VL, Whelton P, Roccella EJ, et al: Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey 1988–1991. Hypertension. 1995;25(3):305–313.

3. Staessen JA, Gasowski J, Wang JG, et al: Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet 2000;355(9207):865–872.

4. Bangalore S, Messerli FH, Wun CC, et al: Treating to New Targets Steering Committee and Investigators. J-curve revisited: An analysis of blood pressure and cardiovascular events in the Treating to New Targets (TNT) Trial. Eur Heart J 2010;31(23):2897–2908.

5. Molander L, Lövheim H, Norman T, Nordström P, Gustafson Y: Lower systolic blood pressure is associated with greater mortality in people aged 85 and older. J Am Geriatr Soc 2008;56(10):1853–1859.

6. Satish S, Freeman DH, Ray L, Goodwin JS: The relationship between blood pressure and mortality in the oldest old. J Am Geriatr Soc 2001;49(4):367–374.

7. Boutitie F, Gueyffier F, Pocock S, Fagard R, Boissel JP: INDANA Project Steering Committee. INdividual Data ANalysis of Antihypertensive intervention. J-shaped relationship between blood pressure and mortality in hypertensive patients: new insights from a meta-analysis of individual-patient data. Ann Intern Med 2002;136(6):438–448.

8. Mancia G, Fagard R, Narkiewicz K, 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). Eur Heart J 2013;34(28):2159–2219.

9. Amery A, Birkenhager W, Brixko P, et al: Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet. 1985;1(8442):1349–1354.

10. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991;265(24):3255–3264.

11. Dahlöf B, Lindholm LH, Hansson L, et al.: Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet. 1991;338(8778):1281–1285.

12. Hansson L, Lindholm LH, Ekbom T, et al: Randomised trial of old and new antihypertensive drugs in elderly patients: cardiovascular mortality and morbidity the Swedish Trial in Old Patients with Hypertension-2 study. Lancet 1999;354(9192):1751–1756.

13. Staessen JA, Fagard R, Thijs L, et al: Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet 1997;350(9080):757–764.

14. Liu L, Wang JG, Gong L, Liu G, Staessen JA: Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens 1998;16(12 Pt 1):1823–1829.

15. Medical Research Council trial of treatment of hypertension in older adults: principal results. MRC Working Party. BMJ 1992;304(6824): 405–412.

16. Dahlöf B, Devereux RB, Kjeldsen SE, et al: LIFE Study Group. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 2002;359(9311):995–1003.

17. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288(23):2981–2997.

18. Jamerson K, Weber MA, Bakris GL, et al: ACCOMPLISH Trial Inves-tigators. Benazepril plus amlodipine or hydrochlorothiazide for hyperten-sion in high-risk patients. N Engl J Med 2008;359(23):2417–2428.

19. Gueyffier F, Bulpitt C, Boissel JP, et al: Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group. Lancet 1999;353(9155):793–796.

20. Beckett NS, Peters R, Fletcher AE, et al: HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008;358(18):1887–1898.

21. Ogihara T, Saruta T, Rakugi H, et al: Valsartan in Elderly Isolated Systolic Hypertension Study Group. Target blood pressure for treatment of isolated systolic hypertension in the elderly: valsartan in elderly isolated systolic hypertension study. Hypertension 2010;56(2):196–202.

22. Cífková R, Souček M: Co nového v problematice hypertenze? Kap Kardiol 2011; 3: 3–7.

23. Aronow WS, Fleg JL, Pepine CJ, et al: ACCF Task Force. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation 2011; 123(21):2434–2506.

24. Weber MA, Schiffrin EL, White WB, et al.: Clinical practice guidelines for the management of hypertension in the community. A statement by the American Society of Hypertension and the International Society of Hypertension. J Clin Hypertens 2013;

25. James PA, Oparil S, Carter BL 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 2013 Dec 18.

26. Filipovský J, Widimský J jr, Ceral J, et al.: Diagnostické a léčebné postupy u arteriální hypertenze – verze 2012. Doporučení České společnosti pro hypertenzi. Vnitř Lék 2012;58:785–801.

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