Task Force Members

cardiovascular

Кардиоваскулярная терапия и профилактика

Cardiovascular Therapy and Prevention

1728-88002619-0125

«SILICEA-POLIGRAF» LLC

10.15829/1728-8800-2017-1-8-21

cardiovascular-557

Research Article

СОГЛАСОВАННОЕ МНЕНИЕ ЭКСПЕРТОВ

POSITION AGREEMENT OF THE EXPERTS

ЛЕЧЕНИЕ АРТЕРИАЛЬНОЙ ГИПЕРТОНИИ У ПАЦИЕНТОВ 80 ЛЕТ И СТАРШЕ И ПАЦИЕНТОВ СО СТАРЧЕСКОЙ АСТЕНИЕЙ

ARTERIAL HYPERTENSION MANAGEMENT IN PATIENTS AGED OLDER THAN 80 YEARS AND PATIENTS WITH THE SENILE ASTHENIA

Ткачева

О. Н.

Tkacheva

O. N.

Доктор медицинских наук, профессор, зав. кафедрой болезней старения ФГБОУ ВО РНИМУ им. Н. И. Пирогова МЗ РФ, директор Российского геронтологического научно-клинического центра

Рунихина

Н. К.

Runikhina

N. K.

Доктор медицинских наук, профессор кафедры болезней старения ФГБОУ ВО РНИМУ им. Н. И. Пирогова МЗ РФ, заместитель директора Российского геронтологического научно-клинического центра

Котовская

Ю. В.

Kotovskaya

Yu. V.

Доктор медицинских наук, профессор, зав. кафедрой кардиологии и персонифицированной медицины факультета повышения квалификации медицинских работников медицинского института ФГАОУ ВО РУДН.

Москва, тел.: +7 (916) 634-67-35, e-mail: kotovskaya@bk.ru

kotovskaya@bk.ru

Шарашкина

Н. В.

Sharashkina

N. V.

Кандидат медицинских наук, старший научный сотрудник лаборатории гериатрии Российского геронтологического научно-клинического центра

Остапенко

В. С.

Ostapenko

V. S.

Российский национальный исследовательский медицинский университет имени Н.И. ПироговаRussian FederationРоссийский университет дружбы народовRussian Federation

2017

20022017

161821

2017

Ткачева О.Н., Рунихина Н.К., Котовская Ю.В., Шарашкина Н.В., Остапенко В.С.

Tkacheva O.N., Runikhina N.K., Kotovskaya Y.V., Sharashkina N.V., Ostapenko V.S.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://cardiovascular.elpub.ru/jour/article/view/557

Согласованное мнение экспертов Российской ассоциации геронтологов и гериатров, Геронтологического общества при Российской академии наук, Российского медицинского общества по артериальной гипертонии.

Рабочая группа по подготовке текста: Ткачева О. Н. (председатель), Рунихина Н. К., Котовская Ю. В., Шарашкина Н. В., Остапенко В. С.

Комитет экспертов: Анисимов В. Н., Архипов М. В., Баранова Е. И., Бойцов С. А., Болотнова Т. В., Виллевальде С. В., Галявич А. С., Гринштейн Ю. И., Драпкина О. М., Дупляков Д. В., Жернакова Ю. В., Захарова Н. О., Ильницкий А. Н., Караева Е. В., Карпов Ю. А., Кисляк О. А., Кобалава Ж. Д., Козиолова Н. А., Конради А. О., Мартынов А. И., Медведева И. В., Моисеев В. С., Недогода С. В., Оганов Р. Г., Орлова Я. А., Остроумова О. Д., Ощепкова Е. В., Подзолков В. И., Прощаев К. И.,  Скибицкий В. В., Фомин И. В., Фролова Е. В., Хавинсон В. Х., Чазова И. Е., Чесникова А. И., Чукаева И. И.,  Шабалин В. Н.

A position agreement of the experts of Russian association of gerontologists and geriatricians, Gerontological society of Russian Academy of Sciences, Russian medical society for arterial hypertension

Task Force Members

Task Force Members: Tkacheva O. N. (Chairperson), Runikhina N. K., Kotovskaya Yu. V., Sharashkina N. V., Ostapenko V. S.

Expert Committee

Expert Committee: Anisimov V. N., Arkhipov M. V., Baranova E. I., Boytsov S. A., Bolotnova T. V., Villevalde S. V., Galyavich A. S., Grinshtein Yu. I., Drapkina O. M., Duplyakov D. V., Zhernakova Yu. V., Zakharova N. O., Ilnitsky A. N., Karaeva E. V., Karpov Yu. A., Kisliak O. A., Kobalava Zh. D., Koziolova N. A., Konradi A. O., Martynov A. I., Medvedeva I. V., Moiseev V. S., Nedogoda S. V., Oganov R. G., Orlova Ya. A., Ostroumova O. D., Oschepkova E. V., Podzolkov V. I., Proschaev K. I., Skibitsky V. V., Fomin I. V., Frolova E. V., Khavinson V. Kh., Chazova I. E., Chesnikova A. I., Chukaeva I. I., Shabalin V. N.

артериальная гипертониясиндром старческой астениипожилой и старческий возрастартериальное давление

References1

Forette F, Seux M, Staessen J, et al. Prevention of dementia in a randomised double blind placebo controlled systolic hypertension in Europe (Syst-Eur) trial. Lancet 1998; 352:1347-51.

Xu W, Tan L, Wang H-F, et al. Meta-analysis of modifiable risk factors for Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2015; 86(12): 1299-306.

National Institute on Aging, National Institutes of Health. Global Health and Aging. NIH Publication no. 11-7737. Washington, DC: World Health Organisation; 2011.

Health at a Glance 2009-OECD Indicators.http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0CCIQFjAA&url=http%3A%2F%2Fwww.oecd. org%2Fhealth%2Fhealth-systems%2F44117530.pdf&ei=DvK7VN7SJMXkasibgrAI&usg=AFQjCNHKC9qNe87GdiBIi_VTS0dfWpigg&bvm=bv.83829542,d.d2s&cad=rja).

https://www.rosminzdrav.ru/news/2016/04/13/2895-kollegiya-ministerstva-zdravoohraneniya-rossiyskoy-federatsii-ob-itogah-raboty-ministerstva-v-2015-godu-i-zadachah-na-2016-god

Beckett NS, Peters R, Fletcher AE, et al.; HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358(18): 1887-98.

Aronow WS, Fleg JL, Pepine CJ, et al. ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension. J Am Soc Hypertens 2011; 5: 259-352. doi: 10.1016/j.jash.2011.06.001.

National Institute for Health and Care Excellence. http://www.nice.org.uk/guidance/cg127/resources/guidance-hypertension-pdf.

Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013; 34: 2159-219.

Blacher J, Halimi JM, Hanon O, et al; French Society of Hypertension. Management of hypertension in adults: the 2013 French Society of Hypertension guidelines. Fundam Clin Pharmacol 2014; 28: 1-9.

Benetos А, Bulpitt CJ, Petrovic M, et al. An Expert Opinion from the European society of hypertension-European union geriatric medicine society Working group on the management of hypertension in very old, frail subjects. Hypertension 2016; 67: 820825. DOI: 10.1161/HYPERTENSIONAHA.115.07020.

Poryadok okazaniya meditsinskoj pomoshchi naseleniyu po profilyu geriatriya. Prikaz N 38n ot 29.01.2016. Russian (Порядок оказания медицинской помощи населению по профилю "гериатрия". Приказ № 38н от 29.01.2016. http://kbnmot.ru/index.php/meditsina-i-pravo/obsuzhdenie-normativno-pravovykh-aktov/278-ob-utverzhdenii-poryadka-okazaniya-meditsinskoj-pomoshchi-naseleniyu-po-profilyu-geriatriya

Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontology Series A-Biological Sciences & Medical Sciences. 2004; 59(3): 255-63.

Fisher AL. Just what defines frailty? J Am Geriatrics Society 2007; 53 (12): 2229-30.

Rockwood K. Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med 2011; 27 (1): 7-26.

Yao X. Inflammation and immune system alterations in frailty. Clin Geriatr Med 2011; 27 (1): 79-87.

Qiu C, Winblad B, Fratiglioni L. The age-dependent relation of blood pressure to cognitive function and dementia. Lancet Neurol 2005; 4: 487-99.

Sabayan B, Oleksik AM, Maier AB, et al. High blood pressure and resilience to 45. physical and cognitive decline in the oldest old: the Leiden 85-plus Study. J Am Geriatr Soc 2012; 60: 2014-9. 46.

Taekema DG, Maier AB, Westendorp RG, de Craen AJ. Higher blood pressure is associated with higher handgrip strength in the oldest old. Am J Hypertens 2011; 24:83-9. 47.

Fried LP, Ferrucci L, Darer J, et al. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59(3): 255-63. 48.

Bergman H, Ferrucci L, Guralnik J, et al. Frailty: an emerging research and clinical paradigm—issues and controversies. J Gerontol A Biol Sci Med Sci 2007; 62(7): 49. 731-7.

Shamliyan T, Talley KM, Ramakrishnan R, Kane RL. Association of frailty with survival: 50. a systematic literature review. Ageing Res Rev 2013; 12(2): 719-36.

Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc 2012; 51. 60(8): 1487-92.

Park SK, Richardson CR, Holleman RG, et al. Frailty in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003-2006). Heart Lung 52. 2013; 42(3): 163-70.

Wilhelm-Leen ER, Hall YN, Tamura MK, et al. Frailty and chronic kidney disease: the third National Health and Nutrition Evaluation Survey. Am J Med 2009; 122(7): 664-71.

Gurina NA, Frolova EV, Degriz Ya. Evaluation of health status of the elderly people in a region of Sankt-Peterburg: result of the HRUSTAL project. Advances of gerontology 2011; 24 (1): 114-20. Russian (Гурина Н. А., Фролова Е. В., Дегриз Я. Изучение 53. состояния здоровья пожилых людей в одном из районов Санкт-Петербурга: результаты проекта "ХРУСТАЛЬ". Успехи геронтологии 2011; 24 (1): 114-20).

Cesari M, Gambassi G, Van Kan GA, et al. The frailty phenotype and the frailty index: different instruments for different purposes. Age & Ageing 2014; 43(1): 10-2.

Senn N, Monod S. Development of a Comprehensive Approach for the Early Diagnosis of Geriatric Syndromes in General Practice. Front Med (Lausanne) 2015; 2: 78.

Woo J, Yu R, Wong M, et al. Frailty Screening in the Community Using the FRAIL Scale. 54. J Am Med Dir Assoc 2015; 1: 16(5): 412-9.

Mitnitski AB, Mogilner AJ, MacKnight C, et al. The mortality rate as a function of accumulated deficits in a frailty index. Mech Ageing Dev 2002; 123(11): 1457-60.

Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and 55. frailty in elderly people. CMAJ 2005; 173(5): 489-95.

Longstreth WT Jr, Manolio TA, Arnold A, et al. Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. Stroke 1996; 27: 1274-82. 56.

Skoog I, Lernfelt B, Landahl S, et al. 15-year longitudinal study of blood pressure and dementia. Lancet 1996; 347: 1141-5.

Diehr P, Williamson J, Burke GL, et al. The aging and dying processes and the health of older adults. J Clin Epidemiol 2002; 55: 269-78.

Poortvliet RK, de Ruijter W, de Craen AJ, et al. Blood pressure trends and mortality: 57. the Leiden 85-plus Study. J Hypertens 2013; 31: 63-70.

Freeman R, Wieling W, Axelrod FB, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 2011; 21(2): 69-72.

Bouhanick B, Meliani S, Doucet J, et al. Gerodiab Study group. Orthostatic 58. hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusion. Ann Cardiol Angeiol (Paris) 2014; 63 (3): 176-82. 59.

Finucane C, O'Connell MD, Fan CW, et al. Age-related normative changes in phasic orthostatic blood pressure in a large population study: findings from the Irish Longitudinal Study on Ageing (TILDA). Circulation 2014; 130 (20): 1780-9. 60.

Fedorowski A, Stavenow L, Hedblad B, et al. Orthostatic hypotension predicts all-cause mortality and coronary events in middle-aged individuals (The Malmo Preventive Project). Eur Heart J 2010; 31: 85-91. 61.

Fagard RH, De Cort P. Orthostatic hypotension is a more robust predictor of cardiovascular events than night-time reverse dipping in elderly. Hypertension 2010; 56: 56-61.

Verwoert GC, Matace-Raso FU, Hofman A, et al. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc 62. 2008; 56 (10): 1816-20.

Gangavati A, Hajjar I, Quach L, et al. Hypertension, Orthostatic Hypotension, and the Risk of Falls in a Community-Dwelling Elderly Population: The Maintenance of 63. Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study. J Am Geriatr Soc 2011; 59(3): 383-9.

Benvenuto LJ, Krakoff LR. Morbidity and mortality of orthostatic hypotension: 64. implications for management of cardiovascular disease. Am J Hypertens 2011; 24(2): 135-44.

Shen S, He T, Chu J, et al. Uncontrolled hypertension and orthostatic hypotension in 65. relation to standing balance in elderly hypertensive patients. Clin Interv Aging 2015; 10: 897-9.

Kario K. Orthostatic hypertension — a new haemodynamic cardiovascular risk factor. Nat Rev Nephrol 2013; 9(12): 726-38.

Clark CE, Taylor RS, Shore AC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet 2012; 379(9819): 905-14.

English JA, Carell ES, Guidera SA, et al. Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization. Catheter Cardiovasc Interv 2001; 54(1): 8-11.

Agarwal R, Bunaye Z, Bekele DM. Prognostic significance of between-arm blood pressure differences. Hypertension 2008; 51: 657-62.

Verberk WJ, Kessels AG, Thien T. Blood pressure measurement method and inter-arm differences: a meta-analysis. Am J Hypertens 2011; 24(11): 1201-8.

Canepa M, Milaneschi Y, Ameri P, et al. Relationship between inter-arm difference in systolic blood pressure and arterial stiffness in community-dwelling older adults. J Clin Hypertens (Greenwich) 2013; 15(12): 880-7.

Kimura A, Hashimoto J, Watabe D, et al. Patient characteristics and factors associated with inter-arm difference of blood pressure measurements in a general population in Ohasama, Japan. J Hypertens 2004; 22(12): 2277-83.

Khokhlov RA, Gaydashev AE, Akhmedzhanov NM. Predictors of atherosclerotic lesions of limb arteries according to cardioangiological screening of the adult population. Ratsional'naya pharmacoterapiya v kardiologii = Rational pharmacotherapy in cardiology 2015; 11(5): 470-6. Russian (Хохлов Р. А., Гайдашев А. Э., Ахмеджанов Н. М. Предикторы атеросклеротического поражения артерий конечностей по данным кардиоангиологического скрининга взрослого населения. Рациональная фармакотерапия в кардиологии 2015; 11(5): 470-6.

Kobalava ZD, Kotovskaya YV, Ashraful A, et al. Inter-arm difference and orthostatic changes of brachial blood pressure in the very elderly patients under antihypertensive treatment. "Arterial'naya Gipertenziya" ("Arterial Hypertension"). 2016; 22(1): 52-60. Russian (Кобалава Ж.Д., Котовская Ю. В., Ашрафул А. и др. Различия между руками и ортостатические изменения артериального давления в плечевой артерии у очень пожилых пациентов с артериальной гипертензией на фоне медикаментозной терапии. Артериальная гипертензия 2016; 22(1): 52-60).

Beckett N, Peters R, Tuomilehto J, et al. HYVET Study Group. Immediate and late benefits of treating very elderly people with hypertension: results from active treatment extension to Hypertension in the Very Elderly randomised controlled trial. BMJ 2012; 344: d7541.

Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens 2014; 32: 3-15.

Chazova IE, Oshepkova EV, Zhernakova YuV. Clinical guidelines diagnostics and treatment of arterial hypertension. Kardiologicheskij Vestnik 2015; 1: 3-31. Russian (Чазова И. Е., Ощепкова Е. В., Жернакова Ю. В. Клинические рекомендации по диагностике и лечению артериальной гипертонии. Кардиологический Вестник 2015; 1: 3-31).

Warwick J, Falaschetti E, Rockwood K, et al. No evidence that frailty modifies the positive impact of antihypertensive treatment in very elderly people: an investigation of the impact of frailty upon treatment effect in the HYpertension in the Very Elderly Trial (HYVET) study, a double-blind, placebo-controlled study of antihypertensives in people with hypertension aged 80 and over. BMC Med 2015; 13: 78. Odden MC, Covinsky KE, Neuhaus JM, et al. The association of blood pressure and mortality differs by selfreported walking speed in older Latinos. J Gerontol A Biol Sci Med Sci 2012; 67: 977-83.

Ogliari G, Westendorp RG, Muller M, et al. Blood pressure and 10-year mortality risk in the Milan Geriatrics 75+ Cohort Study: role of functional and cognitive status. Age Ageing 2015; 44: 932-7.

Benetos A, Buatois S, Salvi P, et al. Blood pressure and pulse wave velocity values in the institutionalized elderly aged 80 and over: baseline of the PARTAGE study. J Hypertens 2010; 28: 41-50.

Benetos A, Gautier S, Labat C, et al. Mortality and cardiovascular events are best predicted by low central/peripheral pulse pressure amplification but not by high blood pressure levels in elderly nursing home subjects: the PARTAGE (Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population) study. JACC 2012; 60: 1503-11.

Benetos A, Labat C, Rossignol P, et al. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents: The PARTAGE Study. JAMA Intern Med 2015; 175: 989-95.

Mossello E, Pieraccioli M, Nesti N, et al. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med 2015; 175: 578-85.

Angelousi A, Girerd N, Benetos A, et al. Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and meta-analysis. J Hypertens 2014; 32: 1562-71.

Butt DA, Mamdani M, Austin PC, et al. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med 2012; 172: 1739-44.

van der Wardt V, Logan P, Conroy S, et al. Antihypertensive treatment in people with dementia. J Am Med Dir Assoc 2014; 15: 620-9.

Muller M, Smulders YM, de Leeuw PW, et al. Treatment of hypertension in the oldest 77. old: a critical role for frailty? Hypertension 2014; 63: 433-41.

Corrao G, Mazzola P, Monzio Compagnoni M, et al. Antihypertensive Medications, 78. Loop Diuretics, and Risk of Hip Fracture in the Elderly: A Population-Based Cohort Study of 81,617 Italian Patients Newly Treated Between 2005 and 2009. Drugs Aging 2015; 32: 927-36.

Rosendorff C, Lackland DT, Allison M, et al; American Heart Association, American 79. College of Cardiology, and American Society of Hypertension. Treatment of hypertension in patients with coronary artery disease: a scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Hypertension 2015; 65(6): 1372-407. 80.

James PF, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Report From the Panel Members 81. Appointed to the Eighth Joint National Committee (JNC 8). JAMA 20145; 311(5): 507-20. 82.

Rakugi H, Ogihara T, Goto Y, et al. JATOS Study Group. Comparison of strictand mild-blood pressure control in elderly hypertensive patients: a per-protocol analysis of JATOS. Hypertens Res 2010; 33: 1124-8.

Ogihara T, Saruta T, Rakugi H, et al.; Valsartan in Elderly Isolated Systolic Hypertension Study Group. Target blood pressure for treatment of isolated systolic hypertension in 83. the elderly: valsartan in elderly isolated systolic hypertension study. Hypertension 2010; 56: 196-202. 84.

Foster-Dingley JC, Moonen JE, de Craen AJ, et al. Blood pressure is not associated with cerebral blood flow in older persons. Hypertension 2015; 66: 954-60. 85.

Lipsitz LA, Habtemariam D, Gagnon M, et al. Reexamining the effect of antihypertensive medications on falls in old age. Hypertension 2015; 66: 183-9.

Vidal-Petiot E, Ford I, Greenlaw N, et al. CLARIFY Investigators. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: an international cohort study. Lancet 2016; 388(10056): 2142-52.

Research Group; Wright JT Jr, Williamson JD, Whelton PK, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 2015; 373: 2103-16.

Ogihara T, Saruta T, Rakugi H, et al.; COLM Investigators. Combination therapy of hypertension in the elderly: a subgroup analysis of the Combination of OLMesartan and a calcium channel blocker or diuretic in Japanese elderly hypertensive patients trial. Hypertens Res 2015; 38: 89-96.

Blood Pressure Lowering Treatment Trialists' Collaboration. Effects of different blood pressure-lowering regimens on major cardiovascular vents in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials. Arch Intern Med 2005; 165: 1410-9.

Khan N, McAlister FA. Re-examining the efficacy of beta-blockers for the treatment of hypertension: a meta-analysis. CMAJ 2006; 174: 1737-42.

Wiysonge CS, Bradley H, Mayosi BM, et al. Beta-blockers for hypertension. Cochrane Database Syst Rev 2007;1:CD002003.

Cardiovascular risc and chronic kidney disease: cardio-nephroprotection strategies. Russian Journal of cardiology 2014; 8(112): 7-37. Russian (Национальные рекомендации "Сердечно-сосудистый риск и хроническая болезнь почек: стратегии кардио-нефропротекции". Российский кардиологический журнал 2014; 8(112): 7-37).

Ebert TJ, Morgan BJ, Barney JA, et al. Effects of aging on baroreflex regulation of sympathetic activity in humans. Am J Physiol1992; 263(3 pt 2): H798-803.

Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf 2014; 13: 57-65.

Benetos A, Rossignol P, Cherubini A, et al. Polypharmacy in the aging patient: management of hypertension in octogenarians. JAMA 2015; 314: 170-80.

The authors declare that there are no conflicts of interest present.