Hypertension treatment targets, older patients and lifestyle measures
THE CONTEXT
Hypertension management combines blood pressure targets, regular follow-up, lifestyle changes and adjustment of drug treatment when control is inadequate.
Blood pressure targets and follow-up
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The passage reports an optimum blood pressure of 139/83 mmHg for reducing major cardiovascular events, with an even lower optimum in patients with diabetes mellitus.
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For patients younger than 80 years, the listed targets are clinic blood pressure below 140/90 mmHg and ambulatory or home blood pressure below 135/85 mmHg.
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For patients aged 80 years or older, the listed targets are clinic blood pressure below 150/90 mmHg and ambulatory or home blood pressure below 140/85 mmHg.
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Both systolic and diastolic targets should be attained. Ambulatory or home values refer to average blood pressure during waking hours.
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Screening and detection strategies address previously undetected hypertension. Treatment can be stepped up when lifestyle modification and first-line drug therapy fail to control blood pressure.
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Patients receiving antihypertensive therapy require regular follow-up to monitor blood pressure, minimise side-effects and reinforce lifestyle advice.
Hypertension in older people
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Hypertension, including isolated systolic hypertension, affects more than half of people older than 60 years.
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It is described as the most important risk factor for myocardial infarction, heart failure and stroke in older people.
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The absolute benefit of treatment is greatest in older people, at least up to age 80 years. Antihypertensive treatment is tolerated as well as in younger patients.
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Targets may be relaxed to 150/90 mmHg in older people. Low-dose thiazides are the stated drugs of choice, although coexistent gout or diabetes may make other agents more appropriate.
Lifestyle treatment
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Lifestyle measures may avoid the need for drugs in borderline hypertension, reduce the dose or number of drugs required in established hypertension, and directly reduce cardiovascular risk.
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Correcting obesity, reducing alcohol intake, restricting salt, exercising regularly and increasing fruit and vegetable consumption can lower blood pressure.
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Stopping smoking, eating oily fish and adopting a diet low in saturated fat may further reduce cardiovascular risk independently of blood pressure changes.