Target blood pressure levels in patients with arterial hypertension and frailty
https://doi.org/10.26442/2075082X.2019.4.190577
Abstract
Arterial hypertension (AH) is an important public health problem worldwide. The high prevalence of hypertension can partially be explained by an increase in blood pressure (BP) with age and a rapid increase in the elderly population (over 65 years old). Despite the effect of age on BP, evidence of target blood pressure values for its control in patients of older age groups with AH is limited, especially if they have frailty. There are data from a number of studies that reveal a relationship between lower BP levels and all-cause mortality in patients with AH in older age groups. In clinical practice, decisions regarding BP targets are especially difficult in elderly people with frailty who often do not meet the criteria for inclusion in randomized controlled trials and for this group of elderly people the clinical recommendations of leading communities do not give a specific answer about the target BP level. The evidence base regarding the target BP values in the treatment of AH in patients of older age groups with frailty presented in this review is not numerous, but its analysis suggests the advantages of higher BP numbers, with maximum systolic BP values of 165 mm Hg and diastolic BP of 90 mm Hg, while lower BP levels may be unsafe in terms of increasing the risk of adverse cardiovascular events and mortality from both cardiovascular causes and all causes. Polymorbidity in combination with polypharmacy and an increased risk of adverse events require a patient-oriented individual approach to the appointment of antihypertensive therapy. For a final decision on the management tactics of patients with AH and frailty, large, specially designed randomized clinical trials are needed.
About the Authors
O. D. Ostroumova
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
M. S. Cherniaeva
Central State Medical Academy of the President of the Russian Federation; Hospital for War Veterans №2
Russian Federation
Russian Federation
A. P. Morozov
Hospital for War Veterans №2
Russian Federation
Russian Federation
References
1. https://www.minfin.ru/ common/upload/library/2017/10/main/ buklet_inet_130x300.pdf
2. http://www.who.int/ health_financing/topics/resource-tracking/ghed-update/en/
3. Foy A.J, Mandrola J.M. Heavy Heart: The economic burden of heart disease in the United States Now and in the future. Prim Care 2018; 45 (1): 17-24. DOI: 10.1016/j.pop.2017.11.002
4. Шальнова С.А., Баланова Ю.А., Константинов В.В. и др. Артериальная гипертония: распространенность, осведомленность, прием антигипертензивных препаратов и эффективность лечения среди населения Российской Федерации. Рос. кардиологич. журн. 2006; 4: 45-50.
5. Chow C.K, Teo K.K, Rangarajan S et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013; 310: 959-68. DOI: 10.1001/jama.2013.184182
6. Шальнова С.А., Деев А.Д., Вихирева О.В. и др. Распространенность артериальной гипертонии в России. Информированность, лечение, контроль. Профилактика заболеваний и укрепление здоровья. 2001; 2: 3-7. [Shal'nova S.A., Deev A.D., Vikhireva O.V. et al. The prevalence of arterial hypertension in Russia. Awa-reness, treatment, control. Profilaktika zabolevanii i ukreplenie zdorov'ia. 2001; 2: 3-7 (in Russian).]
7. Трубин В., Николаева Н., Палеева М., Гавдифаттова С. Пожилое население России: проблемы и перспективы. Соц. бюллетень. 2016; 5: 3-45. [Trubin V., Nikolaeva N., Paleeva M., Gavdifattova S. The elderly population of Russia: problems and prospects. Sots. biulleten'. 2016; 5: 3-45. (Russian).]
8. Forouzanfar M.H, Liu P, Roth G.A et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA 2017; 317: 165-82. DOI: 10.1001/jama.2016.19043
9. ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39 (33): 3021-104. DOI: 10.1093/eurheartj/ehy339
10. Beckett N.S, Peters R, Fletcher A.E et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358 (18): 1887-98. DOI: 10.1056/NEJMoa0801369
11. Law M.R, Morris J.K, Wald N.J. Use of blood pressure lowering drugs in the prevention of cardiovascu-lar disease: meat-analysis of 147 randomized trials in the context of expectations from prospective epidemiological studies. Br Med J 2009; 338: b1665. DOI: 10.1136/bmj.b1665
12. Zanchetti A, Thomopoulos C, Parati G. Randomized controlled trials of blood pressure lowering in hypertension: a critical reappraisal. Circ Res 2015; 116: 1058-107. DOI: 10.1161/CIRCRESA-HA.116.303641
13. Grassi G, Quarti-Trevano F, Casati A, Dell’Oro R. Threshold and target for blood pressure lowering in the elderly. Curr Atheroscler Rep 2016; 18 (12): 70. DOI: 10.1007/s11883-016-0627-9
14. SPRINT Research Group, Wright J.T Jr, Williamson J.D et al. A randomized trial of intensive versus stan-dard blood-pressure control. N Engl J Med 2015; 373 (22): 2103-16. DOI: 10.1056/NEJMoa1511939
15. Ettehad D, Emdin C.A, Kiran A et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387: 957-67. DOI: 10.1016/S0140-6736(15)01225-8
16. Mancia G, Fagard R, Narkiewicz K et al. 2013 ESH/ESC guidelines for the management of arterial hy-pertension: 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: 2159-219. DOI: 10.1097/01.hjh.0000431740.32696.cc
17. Zanchetti A, Grassi G, Mancia G. When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical reappraisal. J Hypertens 2009; 27: 923-34. DOI: 10.1097/HJH.0b013e32832aa6b5
18. Benetos A, Bulpitt C.J, Petrovic M et al. An expert opinion from the European Society of Hypertension-European Union Geriatric Medicine Society Working Group on the management of hypertension in very old, frail subjects. Hypertension 2016; 67: 820-5. DOI: 10.1161/HYPERTENSIONAHA.115.07020
19. Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии. 2019; 16 (1): 6-31. DOI: 10.26442/2075082X.2019.1.190179
20. Черняева М.С., Остроумова О.Д. Целевые уровни систолического и диастолического артериального давления у пациентов с артериальной гипертонией старческого возраста без синдрома старческой астении. Лечебное дело. 2019; 1: 44-58. DOI: 10.24411/2071-5315-2019-12089
21. Клинические рекомендации Старческая астения. Российская ассоциация геронтологов и гериатров (2018). http://aggrb.ru/images/Doc/Asteniya_recomend.pdf
22. Clegg A, Young J, Iliffe S et al. Frailty in elderly people. Lancet 2013; 381 (9868): 752-62. DOI: 10.1016/S0140-6736 (12)62167-9
23. Collard R.M, Boter H, Schoevers R.A et al. Prevalence of frailty in community dwelling older persons: a systematic review. J Am Geriatr Soc 2012; 60 (8): 1487-92. DOI: 10.1111/j.1532-5415.2012.04054.x
24. Kojima G. Prevalence of frailty in nursing homes: A systematic review and metaanalysis. J Am Med Dir Assoc 2015; 16 (11): 940-95. DOI: 10.1016/j.jamda.2015.06.025
25. Buta B.J., Walston J.D, Godino J.G et al. Frailty assessment instruments: systematic characterization of the uses and contexts of highly - cited instruments. Ageing Res Rev 2016; 26: 53-61. DOI: 10.1016/j.arr.2015.12.003
26. Fried L.P, Borhani N.O, Enright P et al. The Cardiovascular Health Study: design and rationale. Ann Epidemiol 1991; 1: 263-76.
27. Fried L.P, Tangen C.M, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol Med Sci 2001; 56 (3): 146-56. DOI: 10.1093/gerona/56.3.m146
28. Mitnitski A.B, Mogilner A.J, Rockwood K. Accumulation of deficits as a proxy measure of aging. Scien-tific World J 2001; 1: 323-36. DOI: 10.1100/tsw.2001.58
29. Guralnik J.M, Simonsick E.M, Ferrucci L et al. A short physical performance battery assessing lower ex-tremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49 (2): M85-94.
30. Guralnik J.M, Ferrucci L, Simonsick E.M et al. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995; 332 (9): 556-61. DOI: 10.1056/NEJM199503023320902
31. Diehr P, Williamson J, Burke G.L, Psaty B.M. The aging and dying processes and the health of older adults. J Clin Epidemiol 2002; 55: 269-78.
32. Van Bemmel T, Holman E.R, Gussekloo J et al. Low blood pressure in the very old, a consequence of imminent heart failure: the Leiden 85-plus Study. J Hum Hypertens 2009; 23: 27-32. DOI: 10.1038/jhh.2008.79
33. Muller M, Smulders Y.M, de Leeuw P.W, Stehouwer C.D. Treatment of hypertension in the oldest old: a critical role for frailty? Hypertension 2014; 63: 433-41. DOI: 10.1161/HYPERTENSIONAHA.113.00911
34. Benetos A, Rossignol P, Cherubini A et al. Polypharmacy in the aging patient: management of hyper-tension in octogenarians. JAMA 2015; 314 (2): 170-80. DOI: 10.1001/jama.2015.7517
35. Sabayan B, Oleksik A.M, Maier A.B et al. High blood pressure and resilience to physical and cognitive decline in the oldest old: the Leiden 85-plus study. J Am Geriatr Soc 2012; 60 (11): 2014-19. DOI: 10.1111/j.1532-5415.2012.04203.x
36. Benetos A, Gautier S, Labat C et al. Mortality and cardiovascular events are best predicted by low central/peripheral pulse pressure amplification but not by high blood pressure levels in elderly nursing home subjects: the PARTAGE (Predictive Values of Blood Pressure and Arterial Stiffness in Insti-tutionalized Very Aged Population) study. J Am Coll Cardiol 2012; 60: 1503-11. DOI: 10.1016/j.jacc.2012.04.055
37. Benetos A, Labat C, Rossignol P et al. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: the PARTAGE Study. JAMA Intern Med 2015; 175 (6): 989-95. DOI: 10.1001/jamainternmed.2014.8012
38. Odden M.C, Covinsky K.E, Neuhaus J.M et al. The association of blood pressure and mortality differs by selfreported walking speed in older Latinos. J Gerontol A Biol Sci Med Sci 2012; 67: 977-83. DOI: 10.1093/gerona/glr245
39. Ogliari G, Westendorp R.G, Muller M et al. Blood pressure and 10-year mortality risk in the Milan Ge-riatrics 75+ Cohort Study: role of functional and cognitive status. Age Ageing 2015; 44: 932-7. DOI: 10.1093/ageing/ afv141
40. Mossello E, Pieraccioli M, Nesti et al. N Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med 2015; 175: 578-85. DOI: 10.1001/ ja-mainternmed.2014.8164
41. Van Hateren K.J, Hendriks S.H, Groenier K.H et al. Frailty and the relationship between blood pressure and mortality in elderly patients with type 2 diabetes (Zwolle Outpatient Diabetes project Integra-ting Available Care-34). J Hypertens 2015; 33 (6): 1162-6. DOI: 10.1097/HJH.0000000000000555
42. Sirola J, Pitkala K.H, Tilvis R.S et al. Definition of frailty in older men according to questionnaire data (RAND-36/SF36): The Helsinki Businessmen Study. J Nutr Health Aging 2011; 15: 783-7.
43. Chang Y.W, Chen W.L, Lin F.G et al. Frailty and its impact on health-related quality of life: a cross-sec-tional study on elder community-dwelling preventive health service users. PLoS One 2012; 7: e038079. DOI: 10.1371/journal.pone.0038079
44. Mansur H.N, Colugnati F.A, Grincenkov FR, Bastos MG. Frailty and quality of life: a cross-sectional stu-dy of Brazilian patients with predialysis chronic kidney disease. Health Qual Life Outcomes 2014; 12:DOI: 10.1186/1477-7525-12-27
45. Odden M.C, Peralta C.A, Haan M.N, Covinsky K.E. Rethinking the association of high blood pressure with mortality in elderly adults: the impact of frailty. Arch Intern Med 2012; 172 (15): 1162-8. DOI: 10.1001/archinternmed.2012.2555
46. Fratiglioni L, Viitanen M, Backman L et al. Occurrence of dementia in advanced age: the study de-sign of the Kungsholmen Project. Neuroepidemiology 1992; 11 (Suppl. 1): 29-36. DOI: 10.1159/000110958
47. Guo Z, Viitanen M, Winblad B. Low blood pressure and five-year mortality in a Stockholm cohort of the very old: possible confounding by cognitive impairment and other factors. Am J Public Health 1997; 87 (4): 623-8. DOI: 10.2105/ajph.87.4.623
48. Post Hospers G, Smulders Y.M, Maier A.B et al. Relation between blood pressure and mortality risk in an older population: role of chronological and biological age. J Intern Med 2015; 277 (4): 488-97. DOI: 10.1111/joim.12284
49. Satish S, Zhang D.D, Goodwin J.S. Clinical significance of falling blood pressure among older adults. J Clin Epidemiol 2001; 54 (9): 961-7.
50. Anker D, Santos-Eggimann B, Santschi V et al. Screening and treatment of hypertension in older adults: less is more? Public Health Rev 2018; 3 (39): 26. DOI: 10.1186/s40985-018-0101-z. eCollection 2018
51. Ravindrarajah R, Hazra N.C, Hamada S et al. Systolic blood pressure trajectory, frailty, and all-cause mortality > 80 years of age: cohort study using electronic health records. Circulation 2017; 135 (24): 2357-68. DOI: 10.1161/CIRCULATIONAHA.116.026687
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Ostroumova O.D., Cherniaeva M.S., Morozov A.P. Target blood pressure levels in patients with arterial hypertension and frailty. Systemic Hypertension. 2019;16(4):52-60. (In Russ.) https://doi.org/10.26442/2075082X.2019.4.190577
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