Do we AGREE on the targets of antihypertensive drug treatment in older adults: a systematic review of guidelines on primary prevention of cardiovascular diseases
Abstract Background translation of the available evidence concerning primary cardiovascular prevention into clinical guidance for the heterogeneous population of older adults is challenging. With this review, we aimed to give an overview of the thresholds and targets of antihypertensive drug therapy...
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| Veröffentlicht in: | Age and ageing 2022-01, Vol.51 (1) |
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| creator | Bogaerts, Jonathan M K von Ballmoos, Leonie M Achterberg, Wilco P Gussekloo, Jacobijn Streit, Sven van der Ploeg, Milly A Drewes, Yvonne M Poortvliet, Rosalinde K E |
| description | Abstract
Background
translation of the available evidence concerning primary cardiovascular prevention into clinical guidance for the heterogeneous population of older adults is challenging. With this review, we aimed to give an overview of the thresholds and targets of antihypertensive drug therapy for older adults in currently used guidelines on primary cardiovascular prevention. Secondly, we evaluated the relationship between the advised targets and guideline characteristics, including guideline quality.
Methods
we systematically searched PubMed, Embase, Emcare and five guideline databases. We selected guidelines with (i) numerical thresholds for the initiation or target values of antihypertensive drug therapy in context of primary prevention (January 2008–July 2020) and (ii) specific advice concerning antihypertensive drug therapy in older adults. We extracted the recommendations and appraised the quality of included guidelines with the AGREE II instrument.
Results
thirty-four guidelines provided recommendations concerning antihypertensive drug therapy in older adults. Twenty advised a higher target of systolic blood pressure (SBP) for octogenarians in comparison with the general population and three advised a lower target. Over half of the guidelines (n = 18) recommended to target a SBP |
| doi_str_mv | 10.1093/ageing/afab192 |
| format | Article |
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Background
translation of the available evidence concerning primary cardiovascular prevention into clinical guidance for the heterogeneous population of older adults is challenging. With this review, we aimed to give an overview of the thresholds and targets of antihypertensive drug therapy for older adults in currently used guidelines on primary cardiovascular prevention. Secondly, we evaluated the relationship between the advised targets and guideline characteristics, including guideline quality.
Methods
we systematically searched PubMed, Embase, Emcare and five guideline databases. We selected guidelines with (i) numerical thresholds for the initiation or target values of antihypertensive drug therapy in context of primary prevention (January 2008–July 2020) and (ii) specific advice concerning antihypertensive drug therapy in older adults. We extracted the recommendations and appraised the quality of included guidelines with the AGREE II instrument.
Results
thirty-four guidelines provided recommendations concerning antihypertensive drug therapy in older adults. Twenty advised a higher target of systolic blood pressure (SBP) for octogenarians in comparison with the general population and three advised a lower target. Over half of the guidelines (n = 18) recommended to target a SBP <150 mmHg in the oldest old, while four endorsed targets of SBP lower than 130 or 120 mmHg. Although many guidelines acknowledged frailty, only three gave specific thresholds and targets. Guideline characteristics, including methodological quality, were not related with the recommended targets.
Conclusion
the ongoing debate concerning targets of antihypertensive treatment in older adults, is reflected in an inconsistency of recommendations across guidelines. Recommended targets are largely set on chronological rather than biological age.</description><identifier>ISSN: 0002-0729</identifier><identifier>EISSN: 1468-2834</identifier><identifier>DOI: 10.1093/ageing/afab192</identifier><identifier>PMID: 34718378</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Aged, 80 and over ; Antihypertensive Agents - adverse effects ; Antihypertensives ; Blood Pressure ; Cardiovascular diseases ; Cardiovascular Diseases - diagnosis ; Cardiovascular Diseases - drug therapy ; Cardiovascular Diseases - prevention & control ; Drug abuse ; Drug therapy ; Humans ; Hypertension - diagnosis ; Hypertension - drug therapy ; Inconsistency ; Octogenarians ; Older people ; Prevention ; Primary Prevention ; Systematic Review ; Thresholds ; Translation ; Very old</subject><ispartof>Age and ageing, 2022-01, Vol.51 (1)</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4034-82c0690b8dc8c8d1821bad0672cc0d6835da02dfeaedfe377aaf578aa97d03853</citedby><cites>FETCH-LOGICAL-c4034-82c0690b8dc8c8d1821bad0672cc0d6835da02dfeaedfe377aaf578aa97d03853</cites><orcidid>0000-0001-9227-7135 ; 0000-0002-3813-4616 ; 0000-0001-6438-6705</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,1578,27901,27902,30976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34718378$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bogaerts, Jonathan M K</creatorcontrib><creatorcontrib>von Ballmoos, Leonie M</creatorcontrib><creatorcontrib>Achterberg, Wilco P</creatorcontrib><creatorcontrib>Gussekloo, Jacobijn</creatorcontrib><creatorcontrib>Streit, Sven</creatorcontrib><creatorcontrib>van der Ploeg, Milly A</creatorcontrib><creatorcontrib>Drewes, Yvonne M</creatorcontrib><creatorcontrib>Poortvliet, Rosalinde K E</creatorcontrib><title>Do we AGREE on the targets of antihypertensive drug treatment in older adults: a systematic review of guidelines on primary prevention of cardiovascular diseases</title><title>Age and ageing</title><addtitle>Age Ageing</addtitle><description>Abstract
Background
translation of the available evidence concerning primary cardiovascular prevention into clinical guidance for the heterogeneous population of older adults is challenging. With this review, we aimed to give an overview of the thresholds and targets of antihypertensive drug therapy for older adults in currently used guidelines on primary cardiovascular prevention. Secondly, we evaluated the relationship between the advised targets and guideline characteristics, including guideline quality.
Methods
we systematically searched PubMed, Embase, Emcare and five guideline databases. We selected guidelines with (i) numerical thresholds for the initiation or target values of antihypertensive drug therapy in context of primary prevention (January 2008–July 2020) and (ii) specific advice concerning antihypertensive drug therapy in older adults. We extracted the recommendations and appraised the quality of included guidelines with the AGREE II instrument.
Results
thirty-four guidelines provided recommendations concerning antihypertensive drug therapy in older adults. Twenty advised a higher target of systolic blood pressure (SBP) for octogenarians in comparison with the general population and three advised a lower target. Over half of the guidelines (n = 18) recommended to target a SBP <150 mmHg in the oldest old, while four endorsed targets of SBP lower than 130 or 120 mmHg. Although many guidelines acknowledged frailty, only three gave specific thresholds and targets. Guideline characteristics, including methodological quality, were not related with the recommended targets.
Conclusion
the ongoing debate concerning targets of antihypertensive treatment in older adults, is reflected in an inconsistency of recommendations across guidelines. Recommended targets are largely set on chronological rather than biological age.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antihypertensive Agents - adverse effects</subject><subject>Antihypertensives</subject><subject>Blood Pressure</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - diagnosis</subject><subject>Cardiovascular Diseases - drug therapy</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Drug abuse</subject><subject>Drug therapy</subject><subject>Humans</subject><subject>Hypertension - diagnosis</subject><subject>Hypertension - drug therapy</subject><subject>Inconsistency</subject><subject>Octogenarians</subject><subject>Older people</subject><subject>Prevention</subject><subject>Primary Prevention</subject><subject>Systematic Review</subject><subject>Thresholds</subject><subject>Translation</subject><subject>Very old</subject><issn>0002-0729</issn><issn>1468-2834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqFkc-L1DAUx4so7rh69SgBL3robn60TepBWNZxFRYE0XN4k7x2srTNmKRd5s_xPzXDjIt68ZJHkk8-eY9vUbxk9ILRVlxCj27qL6GDDWv5o2LFqkaVXInqcbGilPKSSt6eFc9ivMtbVjP-tDgTlWRKSLUqfn7w5B7J1c3X9Zr4iaQtkgShxxSJ7whMyW33OwwJp-gWJDbMPUkBIY04JeIm4geLgYCdhxTfESBxHxOOkJwhAReH9wdPPzuLg5swHj7ZBTdC2OeKS7a4fJQZA8E6v0A08wCBWBcRIsbnxZMOhogvTvW8-P5x_e36U3n75ebz9dVtaSoqqlJxQ5uWbpQ1yijLFGcbsLSR3BhqGyVqC5TbDgHzIqQE6GqpAFppqVC1OC_eH727eTOiNbmxAIM-9ao9OP33zeS2uveLVrIWVDRZ8OYkCP7HjDHp0UWDwwAT-jlqXreMs1bSA_r6H_TOz2HK42ne8IbWijUsUxdHygQfY8DuoRlG9SF9fUxfn9LPD179OcID_jvuDLw9An7e_U_2C_tswAY</recordid><startdate>20220106</startdate><enddate>20220106</enddate><creator>Bogaerts, Jonathan M K</creator><creator>von Ballmoos, Leonie M</creator><creator>Achterberg, Wilco P</creator><creator>Gussekloo, Jacobijn</creator><creator>Streit, Sven</creator><creator>van der Ploeg, Milly A</creator><creator>Drewes, Yvonne M</creator><creator>Poortvliet, Rosalinde K E</creator><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7T5</scope><scope>7TK</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-9227-7135</orcidid><orcidid>https://orcid.org/0000-0002-3813-4616</orcidid><orcidid>https://orcid.org/0000-0001-6438-6705</orcidid></search><sort><creationdate>20220106</creationdate><title>Do we AGREE on the targets of antihypertensive drug treatment in older adults: a systematic review of guidelines on primary prevention of cardiovascular diseases</title><author>Bogaerts, Jonathan M K ; von Ballmoos, Leonie M ; Achterberg, Wilco P ; Gussekloo, Jacobijn ; Streit, Sven ; van der Ploeg, Milly A ; Drewes, Yvonne M ; Poortvliet, Rosalinde K E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4034-82c0690b8dc8c8d1821bad0672cc0d6835da02dfeaedfe377aaf578aa97d03853</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antihypertensive Agents - adverse effects</topic><topic>Antihypertensives</topic><topic>Blood Pressure</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - diagnosis</topic><topic>Cardiovascular Diseases - drug therapy</topic><topic>Cardiovascular Diseases - prevention & control</topic><topic>Drug abuse</topic><topic>Drug therapy</topic><topic>Humans</topic><topic>Hypertension - diagnosis</topic><topic>Hypertension - drug therapy</topic><topic>Inconsistency</topic><topic>Octogenarians</topic><topic>Older people</topic><topic>Prevention</topic><topic>Primary Prevention</topic><topic>Systematic Review</topic><topic>Thresholds</topic><topic>Translation</topic><topic>Very old</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bogaerts, Jonathan M K</creatorcontrib><creatorcontrib>von Ballmoos, Leonie M</creatorcontrib><creatorcontrib>Achterberg, Wilco P</creatorcontrib><creatorcontrib>Gussekloo, Jacobijn</creatorcontrib><creatorcontrib>Streit, Sven</creatorcontrib><creatorcontrib>van der Ploeg, Milly A</creatorcontrib><creatorcontrib>Drewes, Yvonne M</creatorcontrib><creatorcontrib>Poortvliet, Rosalinde K E</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Age and ageing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bogaerts, Jonathan M K</au><au>von Ballmoos, Leonie M</au><au>Achterberg, Wilco P</au><au>Gussekloo, Jacobijn</au><au>Streit, Sven</au><au>van der Ploeg, Milly A</au><au>Drewes, Yvonne M</au><au>Poortvliet, Rosalinde K E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Do we AGREE on the targets of antihypertensive drug treatment in older adults: a systematic review of guidelines on primary prevention of cardiovascular diseases</atitle><jtitle>Age and ageing</jtitle><addtitle>Age Ageing</addtitle><date>2022-01-06</date><risdate>2022</risdate><volume>51</volume><issue>1</issue><issn>0002-0729</issn><eissn>1468-2834</eissn><abstract>Abstract
Background
translation of the available evidence concerning primary cardiovascular prevention into clinical guidance for the heterogeneous population of older adults is challenging. With this review, we aimed to give an overview of the thresholds and targets of antihypertensive drug therapy for older adults in currently used guidelines on primary cardiovascular prevention. Secondly, we evaluated the relationship between the advised targets and guideline characteristics, including guideline quality.
Methods
we systematically searched PubMed, Embase, Emcare and five guideline databases. We selected guidelines with (i) numerical thresholds for the initiation or target values of antihypertensive drug therapy in context of primary prevention (January 2008–July 2020) and (ii) specific advice concerning antihypertensive drug therapy in older adults. We extracted the recommendations and appraised the quality of included guidelines with the AGREE II instrument.
Results
thirty-four guidelines provided recommendations concerning antihypertensive drug therapy in older adults. Twenty advised a higher target of systolic blood pressure (SBP) for octogenarians in comparison with the general population and three advised a lower target. Over half of the guidelines (n = 18) recommended to target a SBP <150 mmHg in the oldest old, while four endorsed targets of SBP lower than 130 or 120 mmHg. Although many guidelines acknowledged frailty, only three gave specific thresholds and targets. Guideline characteristics, including methodological quality, were not related with the recommended targets.
Conclusion
the ongoing debate concerning targets of antihypertensive treatment in older adults, is reflected in an inconsistency of recommendations across guidelines. Recommended targets are largely set on chronological rather than biological age.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>34718378</pmid><doi>10.1093/ageing/afab192</doi><orcidid>https://orcid.org/0000-0001-9227-7135</orcidid><orcidid>https://orcid.org/0000-0002-3813-4616</orcidid><orcidid>https://orcid.org/0000-0001-6438-6705</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Applied Social Sciences Index & Abstracts (ASSIA); Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Antihypertensive Agents - adverse effects Antihypertensives Blood Pressure Cardiovascular diseases Cardiovascular Diseases - diagnosis Cardiovascular Diseases - drug therapy Cardiovascular Diseases - prevention & control Drug abuse Drug therapy Humans Hypertension - diagnosis Hypertension - drug therapy Inconsistency Octogenarians Older people Prevention Primary Prevention Systematic Review Thresholds Translation Very old |
| title | Do we AGREE on the targets of antihypertensive drug treatment in older adults: a systematic review of guidelines on primary prevention of cardiovascular diseases |
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