Current guidelines and controversies in the diagnosis and therapy of hypertension in the elderly and very elderly — a review of international recommendations

Abstract

According to the World Health Organization (WHO) arterial hypertension remains the most important cause of death in the world. Due to ageing of the population and the proven importance of high blood pressure in older age, various expert groups dealing with hypertension worldwide have dedicated more and more separate recommendations to elderly (65–79 years of age) and very elderly patients ( > 80 years of age). The subject of this work is to present and compare current guidelines for the diagnosis and treatment of hypertension developed for this demographic segment. Due to the global significance in shaping the views on hypertension, the following Englishlanguage guidelines have been used for comparative analyses in this work: 2017 ACC/AHA Guideline, 2018 ESC//ESH Guidelines, Hypertension Canada’s 2018 Guidelines, 2019 Hypertension in adults: diagnosis and management by National Institute for Health and Care Excellence (NICE), 2016 Guideline for the diagnosis and management of hypertension in adults by National Heart Foundation of Australia. The comparisons have been made based on of blood pressure criteria, the threshold values for drug treatment initiation and the blood pressure target values. In summary, hypertension guidelines for the elderly and very elderly differ significantly, although similar trends in their recommendations are evident.