Hypertension Treatment in Frail Older Adults: A Systematic Review and Appraisal of Guidelines

Overview

Journal Drugs Aging

Specialties Geriatrics
Pharmacology

Date 2023 Aug 18

PMID 37594718

Authors

Kaiyan Hu

Gang Zhou

Mengyao Jiang

Xiaohong Wei

Jing Yu

Li Liu

Zhe Wang

Liyuan Feng

Mei Wu

Tao Li

Bin Ma

Affiliations

Soon will be listed here.

Abstract

Background: Managing hypertension in frail older patients is challenging. Several institutions and organizations have published up-to-date hypertension guidelines suggesting frailty screening among older hypertensive patients, with new recommendations for blood pressure-lowering treatment among the frail population. However, the quality of current hypertension guidelines and the consistency of antihypertension treatment recommendations for frail older patients and their supporting evidence remain unknown.

Objective: In this review, we aimed to systematically collect guidelines with antihypertension treatment recommendations for frail older patients, examine and compare these recommendations, and critically assess reporting and methodology quality of these guidelines.

Methods: A literature search was conducted on two databases and three major websites of guideline development organizations. The AGREE instrument and RIGHT checklist were used to evaluate the methodology and reporting quality of the guidelines, respectively. The consistency of recommendations within the guidelines were compared using descriptive analysis.

Results: We identified 13 hypertension guidelines. The overall methodology quality scores (range 23.35-79.07%) and reporting rates (range 10/35-29/35) varied among these guidelines. Four guidelines provided an explicit definition of frailty. Considering treatment tolerability or increased likelihood of adverse effects while using pharmacotherapy in frail older patients was mentioned in all guidelines. Ten guidelines recommended adjusting blood pressure targets or specific pharmacotherapy programs. Four guidelines recommended using clinical judgment when prescribing. However, the specific recommendations lacked clarity and unity without sufficient evidence.

Conclusions: There were considerable variations in methodology and reporting quality across the 13 included hypertension guidelines. Furthermore, the depth and breadth of antihypertension treatment recommendations for frail older patients were varied and inconsistent. Further trials exploring optimal treatment are urgently required to promote the development of specific guidelines for managing frail older hypertensive patients.

Citing Articles

Deprescribing Cardiovascular Medications in Older Adults Living with Frailty.

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Correlates of Frailty in Hospitalized Older Adults with Hypertension and Its Influence on Clinical Prognosis.

Xu Y, Zhang S, Wang P, Chen Y, Mao Y, Yuan X Int J Gen Med. 2024; 17:3373-3385.

PMID: 39113783 PMC: 11303672. DOI: 10.2147/IJGM.S465973.

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