SSA 01-3 ELDERLY HYPERTENSION; NOT THE CHRONOLOGY BUT THE PATHOPHYSIOLOGY.

The effectiveness of antihypertensive treatment in elderly hypertensive patients has been established through numerous randomized clinical trials including the Hypertension in the Very Elderly Trial (HYVET). However, because of the diversity of biological aging among individuals, chronological age is not the sole determinant for the target blood pressure (BP) level at which antihypertensive medications are aimed. Several conditions, especially frailty, needed be evaluated in managing hypertension among elderly people. Observational studies have reported that strict control of blood pressure could worsen the prognosis in frail elderly hypertensive patients. However, recent subanalysis of the Systolic Blood Pressure Intervention Trial (SPRINT) has demonstrated that frailty status does not influence the main conclusion: that strict BP control targeting systolic BP readings below 120 mmHg was associated with lower cardiovascular morbidity and mortality. Similar findings were also demonstrated in the post hoc analysis of HYVET. However, we should be aware that participants in HYVET and SPRINT did not comprehensively represent the general elderly population.Attention should also be paid to the association between frailty and cognitive impairment-i.e., cognitive frailty. Careful and cautious evaluation is needed because lower BP can aggravate cognition in elderly people, especially those with existing cognitive impairment. Although SPRINT-MIND could provide insight on this concern, further knowledge is needed on how to set a threshold for frailty, as well as cognitive impairment, to properly manage the treatment of elderly hypertensive patients.