Managing Hypertension in the Elderly & Frail:
Finding the Right Balance Between BP Control and Patient Safety
A. Frailty assessment
Apply a clinical frailty scale which is intuitive and easy to use in day-to-day clinical practice
B. Target BP based on age and frailty
1. Aged <85 years AND frailty assessment as mildly frail or below:
120–129/70–79 mmHg if tolerated
2. Aged >85years OR frailty assessment from moderately beyond:
target SBP of <140mmHg
C. Therapy approach: start slow, go slow
1. Monotherapy preferred initially.
2. Long-acting dihydropyridine CCBs or RAS inhibitors (ACE Inhibitors and ARBs) should be considered
D. Close monitoring and risk-benefit
Consideration should include comorbidities, polypharmacy, adherence and functional status
Abbreviations:
ACE inhibitors, Angiotensin-Converting Enzyme inhibitors; ARBs, Angiotensin II Receptor Blockers; BP, blood ACE, angiotensin-converting enzyme; ARBs, Angiotensin Receptor Blockers; BP, blood pressure; CCB, Calcium Channel Blockers; CVD, cardiovascular diseases; HTN, hypertension; RAS, renin-angiotensin system.
References:
1. McEvoy JW, et al. Eur Heart J. 2025 Apr 7;46(14):1300; 2. SCORE2-OP: SCORE2-OP working group and ESC Cardiovascular risk collaboration. Eur Heart J. 2021;42(25):2455-2467. 3. Guasti L et al. Drugs Aging. 2022;39(10):763-772. 4. Egan BM et al. Curr Hypertens Rep. 2024;26(4):157- 167. 5. Fogari R et al. Eur J Clin Pharmacol 2004; 59(12): 863-868. 6. Calvo C et al. J Hypertens 2004; 22(4): 837-846. 7. Diovan core data sheet. Novartis Pharma AG. 8. Malacco E et al. Clin Ther 2004; 26(6): 855-865.
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