2023/05/29 by Giulia Rivasi, Ludovica Ceolin, Marco Capacci +3
Medicine · #Adverse effect #Blood Pressure and Hypertension Studies #Blood pressure #Cardiac, Anesthesia and Surgical Outcomes #Cardiovascular Syncope and Autonomic Disorders #Clinical trial #Environmental health #Gerontology #Intensive care #Intensive care medicine #Internal medicine #Life expectancy #Medicine #Population #Quality of life (healthcare)
paper · pdf · doi:10.33963/kp.a2022.0297
crossref issued 2023/05/29 · crossref published 2023/05/29 · crossref published-online 2023/05/29 · openalex publication_date 2023/05/29 · crossref created 2023/06/01 · crossref deposited 2023/06/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/05 · crossref indexed 2026/08/05
Hypertension management forms a cornerstone of cardiovascular prevention. Strong evidence is available supporting the benefits of blood pressure (BP) lowering in older adults, and recent studies indicate that intensive BP control may provide additional advantages concerning cardiovascular and mortality risk, also at older ages. Yet, in older adults, the cardiovascular benefit of intensive treatment may come at the expense of an increase in adverse events. Indeed, advanced age and frailty may modify the risk/benefit ratio of BP lowering due to a greater predisposition to hypotension and more severe consequences deriving from treatment-related adverse effects. This mostly applies to individuals with poor health status and limited life expectancy, in whom aggressive BP lowering may not lead to cardiovascular benefits but rather increase the risk of short-term treatment-related complications. Furthermore, potential harms of intensive BP control might be underestimated in clinical trials due to exclusion criteria that preclude patients with frailty and multimorbidity from being eligible. Syncope and falls are the most frequently mentioned safety concerns related to antihypertensive treatment, but aggressive BP lowering may affect negatively also renal function, cognitive performance, quality of life, and survival. With the growing emphasis on intensive treatment strategies, raising the awareness of potential harms associated with aggressive BP lowering might help improve hypertension management in older adults and encourage implementation of clinical research on safety. Given these premises, we present a narrative review illustrating the most relevant risks associated with intensive BP control in older patients.