Arterial Hypertension
Arterial hypertension is the most frequent cardiovascular disease and is one of the very important age-related diseases. Elderly people (65+ years) represent the most rapidly growing population cohort in industrialized countries. This development is terme
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Relevance for Elderly Patients, Epidemiology Arterial hypertension is the most frequent cardiovascular disease and is one of the very important age-related diseases. Elderly people (65+ years) represent the most rapidly growing population cohort in industrialized countries. This development is termed demographic revolution, and it is obvious that it will dramatically increase the prevalence of this disease. In 70+-year-old patients, the prevalence of arterial (in particular systolic hypertension >140 mmHg) hypertension is at 70% compared to only 30–50% in younger adults, and it is still on the rise (Plouin et al. 2006). The deleterious effects of hypertension are well known—stroke, myocardial infarction, heart failure, renal failure—all of which massively contribute to morbidity and mortality of aging societies. Of all deaths, 13%, in countries with high income even 18%, are attributable to hypertension (Lawes et al. 2008). In 2001, disability-adjusted life years (DALYs) due to hypertension were most frequent in countries with high income in women aged 60+ years and in men aged 70+ years (Fig. 1). The success of sufficient control of arterial hypertension in terms of morbidity and mortality
M. Wehling (*) University of Heidelberg, Maybachstr. 14, Mannheim 68169, Germany e-mail: [email protected]
reduction is without any reasonable doubt, and this evidence is at least 25 years old. The famous Framingham study was one of the earliest to detect a highly relevant 60% difference of cardiovascular mortality and a 31% difference of total mortality between treated and untreated hypertensives (Sytkowski et al. 1996). Meanwhile, studies have extended evidence for the impressively positive treatment effects into patients of higher age, such as the SYST-EUR study, which demonstrated a 42% reduction of stroke after 4 years of treatment by nitrendipine and enalapril in 60+-year-old patients (Staessen et al. 1999). More recently, HYVET showed a relevant, positive endpoint effect of blood pressure lowering even in 80+-year-old hypertensives (Beckett et al. 2008). The large epidemiological impact of arterial hypertension, especially in the elderly population, and the benefits of drug treatment in terms of relevant endpoint effects demonstrated in controlled clinical trials are not debatable and consistently shown. Arterial hypertension is likely to be the disease whose sufficient treatment results in the biggest gains of QALYs (quality adjusted life years) and preventable deaths. Unfortunately, reality shows a dramatic underutilization of care for this highly prevalent treatable condition. In the United States, the latest Centers for Disease Control and Prevention (CDC) report (Keenan et al. 2011) showed an overall prevalence of hypertension of 29.9% in persons aged 18+ years. This analysis was based on National Health and Nutrition Examination Survey
M. Wehling (ed.), Drug Therapy for the Elderly, DOI 10.1007/978-3-7091-0912-0_6, # Springer-Verlag Wien 2013
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Attributable DALYs (1000s)
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