Chart 14.2. – Challenges in treating SHT in older adults.

Most older adults are hypertensive, with high prevalence of ISH.
The challenges are not limited to age, but primarily to functional, social, nutritional, and mental status.
Survival rate is more closely tied to global functional status than to age itself.
A diagnosis of HT in older adults requires acknowledging their idiosyncrasies and the frequent use of out-of-office monitoring.
Therapeutic challenges are connected to adherence, presence or absence of polypharmacy, orthostatic hypotension, and comorbidities, such as urinary incontinence and fatigue, among others, common in older adults.
Clinical assessments should include functional tests, such as gait speed and the Clinical Frailty Scale.
Treatment prevents CV events, death, and cognitive decline, even at advanced ages.
LSCs work, but require greater care.
DIUs, CCBs, ACEIs/ARBs should be used in isolation or combined as initial therapies; BBs, when there is formal indication for their use.
Weight loss and loss of organ reserve at advanced ages may be associated with gradual decreases in BP and may imply in treatment deintensification.
In older adults receiving palliative care for advanced disease or severe frailty, the primary treatment objective is symptom control.

ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin II AT1 receptor blocker; BB: beta-blocker; CCB: calcium channel blocker; CV: cardiovascular; DIU: diuretic; HT: hypertension; ISH: isolated systolic hypertension; LSC: lifestyle changes.