Traitement de l'hypertension artérielle chez la personne âgée

The use of ambulatory blood pressure measurement methods (home blood pressure measurements or 24 hours ambulatory blood pressure measurements) must be encouraged because the frequency of “white coat” effect increases with aging. It is important to identify patients with sustained hypertension who need antihypertensive drugs and patients with white coat effect where treatment is not justified and could be dangerous because of the risk of hypotension. The objective of the antihypertensive treatment is to decrease SBP/DBP under 140/90 mmHg between 60 and 80 years, and SBP under 150 mmHg over 80 years old without orthostatic hypotension. All classes of antihypertensive drugs can be used, with a preference for the utilization of thiazide diuretics or calcium channel blockers in lack of specific indications due to concomitant diseases. Usually, in very elderly people, the antihypertensive treatment does not include more than 3 antihypertensive drugs at optimal dosage (including a thiazide diuretic).