Page 9 - hypertension_newsletter8

REFLECTIONS
Hypertension
Hypertension Global Newsletter #8 2025

9. Which non-pharmacological therapies should be considered in older adults? Hypertension
Non-pharmacological therapies for older adults with hypertension should include personalised exercise, smoking and
alcohol reduction, cautious weight management, and careful salt restriction, with emphasis on minimising risks such as
malnutrition and frailty.
10. How to start and uptitrate pharmacological treatment in patients aged 80+ years?
Pharmacological treatment in patients aged 80+ should begin with monotherapy, tailored to frailty levels, with a target SBP
of 140–150 mmHg, and uptitration should be slower than in younger patients to avoid adverse effects.
11. What are the specific precautions/problems related to antihypertensive drugs?
Drug-specific side effects can include: 1. hyperkalaemia with ACEI, ARB, and MRA; 2. bradycardia and cardiac
decompensation with BB or non-dihydropyridine CCB especially when both these drug classes are used; 3. hypokalaemia,
hyponatraemia (with MRA), and gout with diuretics, thiazides, and loop diuretics; 4. orthostatic or postprandial hypotension
and syncope in patients with alpha-blockers, centrally acting antihypertensives, and vasodilators.
12. In which situations could antihypertensive treatment be decreased?
Antihypertensive treatment may be decreased in older adults if the risks outweigh the benefits, such as after adverse events
like syncope, falls, or kidney injury, or if the individual experiences persistently low BP (below 120 mmHg) without other
underlying causes.

The authors of this article look to aid in the education of general
CLINICAL PEARLS FROM THE FACULTY practitioners and other physicians practising the management
of hypertension in older people in the hope that these guidelines
will be applied in daily clinical practice.

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WATCH
VIEW COMMENTARY FROM
DR. FIKRLE ON HOW THIS IMPACT
MANAGEMENT OF OLDER PATIENTS.

Intensive Blood-Pressure Control in Patients with Type 2 Diabetes
Bi Y, et al. N Engl J Med. 2024 Nov 16. doi: 10.1056/NEJMoa2412006. Online ahead of print.

Elevated SBP is the most common coexisting condition among patients with diabetes. Current clinical guidelines recommend
decreasing blood pressure in patients with type 2 diabetes (T2D). However, multiple studies exploring this population’s effective SBP
reduction targets have yielded inconclusive evidence. This Blood Pressure Control Target in Diabetes (BPROAD) study investigated
whether intensive treatment targeting a SBP of less than 120 mmHg would be more effective than standard treatment targeting a
SBP of less than 140 mmHg in reducing the risk of major CVD events among patients with T2D.

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