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What are the risks and benefits of treating hypertension in patients older than 80 years of age?
Treating hypertension in healthy patients older than 80 years of age is effective. Exact targets are uncertain, but the primary trial aimed for 150/80 mm Hg. Benefits are uncertain for the frail elderly or those with orthostasis or standing systolic BP below 140 mm Hg.
Managing hypertension in the elderly is important to reduce cardiovascular risk, but targets should be patient-specific, accounting for comorbidities.8 Consider monitoring standing BP to avoid orthostatic hypotension in the very elderly. Drug side effects or interactions are common and difficult to manage, even in dedicated clinics.9 Treatment adherence is a considerable barrier for achieving targets10; simplifying dosing is an easy way to improve adherence.11 Self-management programs can also improve BP control.12 Hypertension Canada has patient resources13 and a list of approved home BP monitors,14 which might facilitate self-management and improve adherence.15
Tools for Practice articles in Canadian Family Physician are adapted from articles published twice monthly on the Alberta College of Family Physicians (ACFP) website, summarizing medical evidence with a focus on topical issues and practice-modifying information. The ACFP summaries and the series in Canadian Family Physician are coordinated by Dr G. Michael Allan, and the summaries are co-authored by at least 1 practising family physician. Feedback is welcome and can be sent to ac.cpfc@ecitcarprofsloot. Archived articles are available on the ACFP website: www.acfp.ca.
The opinions expressed in Tools for Practice articles are those of the authors and do not necessarily mirror the perspective and policy of the Alberta College of Family Physicians.