Diagnosis and treatment of arterial hypertension in old adults

n connection with the population aging in most countries of the world, the diagnosis and treatment of arterial hypertension (AH), as the most common cardiovascular pathology among the adult population, becomes relevant. The purpose of this article is to highlight the features of the management of elderly patients with hypertension using the latest research data and guidelines. It is concluded that hypertension in old adults is characterized by: high prevalence, isolated increase in systolic blood pressure (BP), which is due to certain pathophysiological mechanisms, more frequent presence of concomitant pathology, which causes difficulties in the treatment of hypertension, a greater frequency of adverse reactions, caused by using of antihypertensive drugs, which is partly due to insufficient diagnosis (no exclusion of the «white coat» effect). The target BP level and treatment strategy depends on the phenotype of elderly patients. Calcium antagonists are the basic drugs for treating hypertension in most elderly patients. In certain situations, diuretics may have an advantage. Both classes can be used as monotherapy and in combination with renin-angiotensin system blockers. The high frequency of adverse reactions, and especially those that impair cognitive function or functional state, necessitates a careful approach to the choice of antihypertensive drugs and their dosage. Lercanidipine is a representative of the class of dihydropyridine calcium antagonists with a low incidence of adverse reactions and certain additional positive effects, which successfully allows its use in elderly hypertensive population. There are situations in which it is possible to consider de-escalation of antihypertensive therapy.

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