Arterial hypertension: which targets in over-75-year people?

Submitted: May 24, 2016
Accepted: May 24, 2016
Published: June 22, 2016
Abstract Views: 1452
PDF: 820
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Arterial hypertension has always been considered the main risk factor in cardiovascular prevention. However, the goals of anti-hypertensive treatment (targets) in the elderly has long been under discussion. The results of the studies in favor of the hypothesis "the lower the better" than those that argue against the existence of the phenomenon of the J-curve, that is, the hypothesis according to which mortality increases to too low pressure values  lower than 115/75 mmHg, are still controversial. However, in elderly patients the association between blood pressure lowering and increased cardiovascular events seems to depend on the general health status, that means the presence of comorbidity, frailty and / or disability. Recent data from the SPRINT study show that the benefit of an intensive blood pressure target (SBP <120 mmHg) compared to a usual target (SBP <140 mmHg), appears to be greater in the oldest hypertensive patients (≥75 years). The cardio-geriatric functional assessment can provide useful information to better stratify the elderly and to define more accurately the pressure targets, the choice is individual.

Riassunto

L’ipertensione arteriosa è da sempre  considerata il fattore di rischio centrale in prevenzione cardiovascolare. Tuttavia gli obbiettivi del trattamento anti-ipertensivo (target pressori) nei soggetti anziani è  da molti anni oggetto di discussione. Il risultati degli studi a favore dell’ipotesi “the lower the better†rispetto a quelli contrari che sostengono l’esistenza del  fenomeno della cosiddetta curva J, l’ipotesi cioè secondo la quale la mortalità aumenta per valori di pressione troppo bassi, inferiori a 115/75 mmHg, sono tutt’ora controversi. Tuttavia in pazienti anziani l’associazione tra riduzione dei valori di pressione arteriosa e aumento degli eventi cardiovascolari  sembra dipendere dallo stato di salute generale, ovvero alla presenza di comorbidità, fragilità e/o disabilità. I recenti dati dello studio SPRINT. Mostrano che il beneficio di un target pressorio intensivo  (PAS<120 mmHg) rispetto ad un target usuale  (PAS<140 mmHg), sembra essere maggiore nei soggetti  ipertesi più anziani (≥75 anni). La valutazione funzionale cardio-geriatrica può fornire informazioni utili a stratificare meglio  i soggetti anziani e a definirne in maniera più accurata i target pressori, la cui scelta rimane individuale.  

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How to Cite

Mureddu, Gian Francesco. 2016. “Arterial Hypertension: Which Targets in over-75-Year People?”. Monaldi Archives for Chest Disease 84 (1-2). https://doi.org/10.4081/monaldi.2015.724.