Rational Pharmacotherapy in Cardiology

Advanced search

Arterial Hypertension in Older Adults in the Light of New European Guidelines 2018

Full Text:


The tendency of aging of the population and,  together with it, the increase in the prevalence of arterial hypertension (HT) determines the need  to study  the  peculiarities of treatment of HT in patients of elderly and  senile age.  In this regard, in the  new  Guidelines of the  European Society of Cardiology for diagnosis and treatment of HT (2018), the authors identified groups  of elderly patients (aged 65-79 years) and very elderly patients (aged ≥80 years), blood pressure (BP) levels for the initiation of antihypertensive therapy and target BP levels, and recommended the main principles of antihypertensive therapy. The new  recommendations of the  ESH/ESC in 2018 also presented the  characteristics of HT management in elderly patients. The necessity of mandatory detection of senile asthenia in elderly patients and  determination of the  degree of their independence from outside help is emphasized. In all elderly patients, especially in very elderly or "fragile" patients, it is recommended to evaluate the  presence or development of orthostatic hypotension during treatment, as well as actively to detect episodes of hypotension using the 24-hour BP monitoring. For antihypertensive therapy in elderly patients, the same five classes of antihypertensive drugs and their combination are recommended. It is emphasized that if it is not required for the treatment of concomitant diseases, loop diuretics and alpha-blockers should be avoided because their use is associated with an increased risk of falls. It is recommended to investigate the level of serum creatinine more often to evaluate the kidney function and to detect a possible decrease in the glomerular filtration rate  because of a decrease in BP and  perfusion of the kidneys. The target BP levels indicated in the Guidelines are: systolic BP values 130-139 mm Hg and diastolic BP 70-80 mm Hg. In the Guidelines it is emphasized that elderly patients need careful monitoring of any adverse  side effects of antihypertensive drugs.

About the Authors

O. D. Ostroumova
A.I. Evdokimov Moscow State University of Medicine and Dentistry; Pirogov Russian National Research Medical University
Russian Federation

Olga D. Ostroumova – MD, PhD, Professor, Chair of Faculty Therapy and Occupational Diseases, A.I. Evdokimov Moscow State University of Medicine and Dentistry; Head of Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontology Clinical Research Center, Pirogov Russian National Research Medical University.

Delegatskaya ul. 20/1, Moscow, 127473; Ostrovitianova ul. 1, Moscow, 117997.


A. I. Kochetkov
A.I. Evdokimov Moscow State University of Medicine and Dentistry; Pirogov Russian National Research Medical University
Russian Federation

Alexey I. Kochetkov – MD, PhD, Assistant, Chair of Faculty Therapy and Occupational Diseases, A.I. Evdokimov Moscow State University of Medicine and Dentistry; Researcher,  Laboratory of Clinical Pharmacology and Pharmacotherapy, Russian Gerontology Clinical Research Center, Pirogov Russian National Research Medical University.

Delegatskaya ul. 20/1, Moscow, 127473; Ostrovitianova ul. 1, Moscow, 117997.


M. S. Cherniaeva
Central State Medical Academy of Administrative Department of the President of the Russian Federation
Russian Federation

Marina  S. Cherniaeva – MD, PhD, Associate Professor, Chair of Internal Medicine and Preventive Medicine.

Marshala Timoshenko ul. 19-1A, Moscow, 121359.



1. Trubin V., Nikolaeva N., Paleeva M., Gavdifattova S. The elderly population of Russia: problems and prospects. Social Bulletin. 2016;5:3-45. (In Russ.).

2. Williams B., Mancia G., Spiering W., et al; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021-104. doi:10.1093/eurheartj/ehy339.

3. Foy A.J., Mandrola J.M. Heavy Heart: The economic burden of heart disease in the United States Now and in the future. Prim Care. 2018;45(1):17-24. doi:10.1016/j.pop.2017.11.002.

4. NCD Risk Factor Collaboration. Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19.1 million participants. Lancet. 2017;389:37-55. doi:10.1016/S0140-6736(16)31919-5.

5. Chow C.K., Teo K.K., Rangarajan S., et al., PURE Study Investigators. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013;310:959-68. doi:10.1001/jama.2013.184182.

6. Kearney P.M., Whelton M., Reynolds K., et al. Global burden of hypertension: analysis of worldwide data. Lancet 2005;365:217-23. doi:10.1016/S0140-6736(05)17741-1.

7. Forouzanfar M.H., Liu P., Roth G.A., et al. Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015. JAMA. 2017;317:165-82. doi:10.1001/jama.2016.19043.

8. Lip G.Y.H., Coca A., Kahan T., et al. Hypertension and cardiac arrhythmias: executive summary of a consensus document from the European Heart Rhythm Association (EHRA) and ESC Council on Hypertension, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLEACE). Eur Heart J Cardiovasc Pharmacother. 2017;3:235-50. doi:10.1093/ehjcvp/pvx019.

9. Gottesman R.F., Albert M.S., Alonso A., et al. Associations between midlife vascular risk factors and 25-year incident dementia in the Atherosclerosis Risk in Communities (ARIC) cohort. JAMA Neurol. 2017;74:1246-54. doi:10.1001/jamaneurol.2017.1658.

10. Rovio S.P., Pahkala K., Nevalainen J., et al. Cardiovascular risk factors from childhood and midlife cognitive performance: the Young Finns study. J Am Coll Cardiol. 2017;69:2279-89. doi:10.1016/j.jacc.2017.02.060.

11. Vishram J.K., Borglykke A., Andreasen A.H., et al, MORGAM Project. Impact of age on the importance of systolic and diastolic blood pressures for stroke risk: the MOnica, Risk, Genetics, Archiving, and Monograph (MORGAM) project. Hypertension. 2012;60:1117-23. doi:10.1161/HYPERTEN-SIONAHA.112.201400.

12. Brown D.W., Giles W.H., Greenlund K.J. Blood pressure parameters and risk of fatal stroke, NHANES II mortality study. Am J Hypertens. 2007;20:338-41. doi:10.1016/j.amjhyper.2006.08.004.

13. Lawes C.M., Rodgers A., Bennett D.A., et al., Asia Pacific Cohort Studies Collaboration. Blood pressure and cardiovascular disease in the Asia Pacific region. J Hypertens. 2003;21:707-16. doi:10.1097/01.hjh.0000052492.18130.07.

14. Franklin S.S., Khan S.A., Wong N.D., et al. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study. Circulation. 1999;100:354-60.

15. Williams B., Lindholm L.H., Sever P. Systolic pressure is all that matters. Lancet. 2008;371:19-2221. doi:10.1016/S0140-6736(08)60804-1.

16. Domanski M., Mitchell G., Pfeffer M., et al, MRFIT Research Group. Pulse pressure and cardiovascular disease-related mortality: follow-up study of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA 2002;287:2677-2683.

17. Franklin S.S., Lopez V.A., Wong N.D., et al. Single versus combined blood pressure components and risk for cardiovascular disease: the Framingham Heart Study. Circulation. 2009;119:243-50. doi:10.1161/CIRCULATIONAHA.108.797936.

18. Beckett N.S., Peters R., Fletcher A.E., et al., HYVET Study Group. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358:1887-98. doi:10.1056/NEJMoa0801369.

19. Briasoulis A., Agarwal V., Tousoulis D., Stefanadis C. Effects of antihypertensive treatment in patients over 65 years of age: a meta-analysis of randomised controlled studies. Heart. 2014;100:317-23. doi:10.1136/heartjnl-2013-304111.

20. Zanchetti A., Grassi G., Mancia G. When should antihypertensive drug treatment be initiated and to what levels should systolic blood pressure be lowered? A critical reappraisal. J Hypertens. 2009;27:923-34. doi:10.1097/HJH.0b013e32832aa6b5.

21. Benetos A., Bulpitt C.J., 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;67:820-5. doi:10.1161/HYPERTENSIONAHA.115.07020.

22. Staessen J.A., Fagard R., Thijs L., et al. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Lancet. 1997;350(9080):757-64.

23. Forette F., Seux M-L., Staessen J.A., et al.; Systolic Hypertension in Europe Investigators. The prevention of dementia with antihypertensive treatment: new evidence from the Systolic Hypertension in Europe (Syst-Eur) study. Arch Intern Med. 2002;162(18):2046-52.

24. Lonn E.M., Bosch J., Lopez-Jaramillo P., et al., HOPE-3 Investigators. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med. 2016;374:2009-20. doi:10.1056/NEJMoa1600175.

25. Brunstrom M., Carlberg B. Association of blood pressure lowering with mortality and cardiovascular disease across blood pressure levels: a systematic review and meta-analysis. JAMA Intern Med. 2018;178:28-36. doi:10.1001/jamainternmed.2017.6015.

26. Beckett N., Peters R., Leonetti G., et al., HYVET Study Group. Subgroup and per-protocol analyses from the Hypertension in the Very Elderly Trial. J Hypertens. 2014;32:1478-87. doi:10.1097/HJH.0000000000000195.

27. Carlberg B. What do we know about the risks of stopping antihypertensive treatment? J Hypertens 2014;32:1400-1. doi:10.1097/HJH.0000000000000200.

28. Beckett N.S., Peters R., Fletcher A.E., 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. doi:10.1056/NEJ-Moa0801369.

29. Peters R., Beckett N., Forette F., et al.; HYVET investigators. Incident dementia and blood pressure lowering in the Hypertension in the Very Elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol. 2008;7(8):683-9. doi:10.1016/S1474-4422(08)70143-1.

30. Papademetriou V., Farsang C., Elmfeldt D., et al.; Study on Cognition and Prognosis in the Elderly study group. Stroke prevention with the angiotensin II type 1-receptor blocker candesartan in elderly patients with isolated systolic hypertension: the Study on Cognition and Prognosis in the Elderly (SCOPE). J Am Coll Cardiol. 2004;44(6):1175-80. doi:10.1016/j.jacc.2004.06.034.

31. Corrao G., Rea F., Monzio Compagnoni M., et al. Protective effects of antihypertensive treatment in patients aged 85 years or older. J Hypertens. 2017;35:1432-41. doi:10.1097/HJH.0000000000001323.

32. Kukes V.G., ed. Clinical pharmacology. Moscow: GEOTAR-Media; 2008. (In Russ.).

33. Pertsev I.M., ed. The interaction of drugs and the effectiveness of pharmacotherapy. Reference manual for doctors and pharmacists. Kharkov: Publishing House "Megapolis"; 2002. (In Russ.).

34. Sychev D.A. Polypharmacy in clinical practice: problems and solutions. A manual for doctors. St. Petersburg: TSOP Profession; 2016. (In Russ.).

35. MacDonald T.M., Williams B., Webb D.J., et al., British Hypertension Society Programme of Prevention And Treatment of Hypertension With Algorithm-based Therapy (PATHWAY). Combination therapy is superior to sequential monotherapy for the initial treatment of hypertension: a double-blind randomized controlled trial. J Am Heart Assoc. 2017;6:e006986. doi:10.1161/JAHA.117.006986.

36. Corrao G., Parodi A., Zambon A., et al. Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practice. J Hypertens. 2010;28:1584-90. doi:10.1097/HJH.0b013e328339f9fa.

37. Gupta A.K., Arshad S., Poulter N.R. Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension. 2010;55:399-407. doi:10.1161/HY-PERTENSIONAHA.109.139816.

38. Corrao G., Mazzola P., Monzio Compagnoni M., et al. Antihypertensive medications, 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.

39. Kjeldsen S.E., Stenehjem A., Os I., et al. Treatment of high blood pressure in elderly and octogenarians: European Society of Hypertension statement on blood pressure targets. Blood Press. 2016;25:333-6.

40. Montastruc J., Laborie I., Bagheri H. Senard M. Drug-Induced Orthostatic Hypotension: A Five-Year Experience in a Regional Pharmacovigilance Centre in France. Clin Drug Invest. 1997;14(1):61-5.

41. Rutan G.H., Hermanson B., Bild D.E., et al. Orthostatic hypotension in older adults: the cardiovascular health study. Hypertension. 1992;19(6 Pt 1):508-19.

42. Fedorowski A., Burri P., Melander O. Orthostatic hypotension in genetically related hypertensive and normotensive individuals. J Hypertens. 2009;27(5):976-82.

43. Räihä I., Luutonen S., Piha J, et al. Prevalence, predisposing factors, and prognostic importance of postural hypotension. Arch Intern Med. 1995;155(9):930-5.

44. Lagro J., Laurenssen N.C., Schalk B.W., et al. Diastolic blood pressure drop after standing as a clinical sign for increased mortality in older falls clinic patients. J Hypertens. 2012;30(6):1195-202. doi:10.1097/HJH.0b013e328352b9fd.

45. Poon I.O., Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther. 2005;30(2):173-8. doi:10.1111/j.1365-2710.2005.00629.x.

46. Goldstein D.S., Robertson D., Esler M., et al. Dysautonomias: clinical disorders of the autonomic nervous system. Ann Intern Med. 2002;137(9):753-63.

47. Mets T. Drug-induced orthostatic hypotension in older patients. Drugs Aging. 1995;6:219-28.

48. Hugues F., Munera Y., Le Jeunne C. Drug-induced orthostatic hypotension. Rev Med Interne. 1992;13:465-70.

49. Masaki K.H., Schatz I.J., Burchfiel C.M., et al. Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program. Circulation. 1998;98(21):2290-5.

50. Verwoert G.C., Mattace-Raso F.U., Hofman A., et al. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc. 2008;56(10):1816-20. doi:10.1111/j.1532-5415.2008.01946.x.

51. Fleg J.L., Evans G.W., Margolis K.L., et al. Orthostatic Hypotension in the ACCORD Blood Pressure Trial: Prevalence, Incidence, and Prognostic Significance. Hypertension. 2016;68(4):888-95. doi:10.1161/HYPERTENSIONAHA.116.07474.

52. Fedorowski A., Hedblad B., Melander O. Early postural blood pressure response and cause-specific mortality among middle-aged adults. Eur J Epidemiol. 2011;26(7):537-46. doi:10.1007/s10654-011-9578-1.

53. Ricci F., Fedorowski A. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J. 2015;36:1609-17. doi:10.1093/eurheartj/ehv093.

54. Eigenbrodt M.L., Rose K.M., Couper D.J., et al. Orthostatic hypotension as a risk factor for stroke: the Atherosclerosis Risk in Communities (ARIC) study, 1987-1996. Stroke. 2000;31(10):2307-13.

55. Manolio T.A., Kronmal R.A., Burke G.L., et al. Short-term predictors of incident stroke in older adults. The Cardiovascular Health Study. Stroke. 1996;27(9):1479-86.

56. Elmstahl S., Widerstrom E. Orthostatic intolerance predicts mild cognitive impairment: incidence of mild cognitive impairment and dementia from the Swedish general population cohort Good Aging in Skane. Clin Interv Aging. 2014;9:1993-2002. doi:10.2147/CIA.S72316.

57. Sonnesyn H., Nilsen D.W., Rongve A., et al. High prevalence of orthostatic hypotension in mild dementia. Dement Geriatr Cogn Disord. 2009;28(4):307-13. doi:10.1159/000247586.

58. Mehrabian S., Duron E., Labouree F., et al. Relationship between orthostatic hypotension and cognitive impairment in the elderly. J Neurol Sci. 2010;299(1-2):45-8. doi:10.1016/j.jns.2010.08.056.

59. Frewen J., Finucane C., Savva G.M., et al. Orthostatic hypotension is associated with lower cognitive performance in adults aged 50 plus with supine hypertension. J Gerontol A Biol Sci Med Sci. 2014;69(7):878-85. doi:10.1093/gerona/glt171.

60. Wolters F.J., Mattace-Raso F.U., Koudstaal P.J., et al. and Heart Brain Connection Collaborative Research Group Orthostatic Hypotension and the Long-Term Risk of Dementia: A Population-Based Study. PLOS Med. 2016;13(10):e1002143. doi:10.1371/journal.pmed.1002143.

61. Franceschini N., Rose K.M., Astor B.C., et al. Orthostatic hypotension is associated with incident chronic kidney disease: The Atherosclerosis Risk In Communities Study. Hypertension. 2010;56(6):1054-9. doi:10.1161/HYPERTENSIONAHA.110.156380.

62. Brignole M., Moya A., de Lange F.J., et al.; ESC Scientific Document Group. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39(21):1883-948. doi:10.1093/eurheartj/ehy037.

63. Craig G. Clinical presentation of orthostatic hypotension in the elderly. Postgrad Med J. 1994; 70:638-42.

64. Zia A., Kamaruzzaman S.B., Tan M.P. Blood pressure lowering therapy in older people: does it really cause postural hypotension or falls? Postgrad Med. 2015;127:186-93. doi:10.1080/00325481.2015.996505.

65. Lokshina A.B., Zakharov B.B. Cognitive impairment in clinical practice. Vrach. 2009;4:21-5. (In Russ.).

66. Diagnostic and statistical manual of mental diseases (DSM-V). 5th ed. London: American Psychiatric Association; 2013.

67. Skoog I., Lernfelt B., Landahl S., et al. 15-years longitudinal study of blood pressure and dementia. Lancet, 1996; 347(9009): 1141-1145.

68. Elias P.K., D’Agostino R.B., Elias M.F., Wolf P.A. Blood pressure, hypertension, and age as risk factors for poor cognitive performance. Exp Aging Res. 1995;21(4):393-417. doi:10.1080/03610739508253992.

69. Singh-Manoux A, Marmot M. High blood pressure was associated with cognitive function in middle-age in the Whitehall II study. J Clin Epidemiol. 2005;58(12):1308-15. doi:10.1016/j.jclinepi.2005.03.016.

70. Marpillat N.L., Macquin-Mavier I., Tropeano A-I., et al. Antihypertensive classes, cognitive decline andincidence of dementia: a networkmeta-analysis. Journal of Hypertension. 2013;31(6):1073-82. doi:10.1038/hr.2014.33.

71. Skoog I., Lithell H., Hansson L., et al. Effect of baseline cognitive function and antihypertensive treatment on cognitive and cardiovascular outcomes: Study on COgnition and Prognosis in the Elderly (SCOPE). Am J Hypertens. 2005;18(8):1052-9. doi:10.1016/j.amjhyper.2005.02.013.

72. Clinical guidelines. Senile asthenia. Russian Association of Gerontologists and Geriatrics (2018). [Cited by October 10, 2014]. Available at: (In Russ.).

73. Clegg A., Young J., Iliffe S., et al. Frailty in elderly people. Lancet. 2013;381(9868):752-62. doi:10.1016/S0140-6736(12)62167-9.

74. Collard R.M., Boter H., Schoevers R.A., et al. Prevalence of frailty in community dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60(8):1487-92. doi:10.1111/j.1532-5415.2012.04054.x.

75. Kojima G. Prevalence of frailty in nursing homes: A systematic review and metaanalysis. J Am Med Dir Assoc. 2015;16(11):940-95. doi:10.1016/j.jamda.2015.06.025.

76. Brown M., Sinacore D.R., Ehsani A.A. et al. Low-Intensity Exercise as a Modifier of Physical Frailty in Older Adults. Arch Phys Med Rehab. 2000;81(7):960-65.

77. Chandler J.M., Duncan P.W., Kochersberger G., Studenski S. Is Lower Extremity Strength Gain Associated with Improvement in Physical Performance and Disability in Frail, Community-Dwelling Elders? Arch Phys Med Rehab. 1998;79(1):24-30.

78. Guralnik J.M., Simonsick E.M., Ferrucci L., et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85-94.

79. Guralnik J.M., Ferrucci L., Simonsick E.M., et al. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556-61. doi:10.1056/NEJM199503023320902.

80. Izquierdo M., LusaCadore E. Muscle Power Training in the Institutionalized Frail: A New Approach to Counteracting Functional Declines and Very Late-Life Disability. Curr Med Res Opin. 2014;30(7):1385-90. doi:10.1185/03007995.2014.908175.

81. Gill T.M., Baker D.I., Gottschalk M., et al. A Program to Prevent Functional Decline in Physically Frail, Elderly Persons Who Live at Home. New Engl J Med. 2002;347(14):1068-74. doi:10.1056/NEJ-Moa020423.

82. Willich S.N., Levy D., Rocco M.B., et al. Circadian variation in the incidence of sudden cardiac death in the Framingham Heart Study population. Am J Cardiol. 1987;60(10):801-6.

83. Elliott W.J. Circadian variation in the timing of stroke onset. А meta-analysis. Stroke. 1998;29(5):992-6.

84. Kario K. Morning surge in blood pressure and cardiovascular risk: evidence and perspectives. Hypertension. 2010;56(5):765-73. doi:10.1161/HYPERTENSIONAHA.110.157149.

85. Lacourciere Y., Asmar R. A comparison of the efficacy and duration of action of candesartan cilexetil and losartan as assessed by clinic and ambulatory blood pressure after a missed dose, in truly hypertensive patients. A placebo-controlled, forced titration study. Am J Hypertens. 1999;12(12 Pt 1-2):1181-7.

86. Vanderheyden P.M.L., Fierens F.L.P., De Backer J.P., et al. Distinction between surmountable and insurmountable selective AT1 receptor antagonists by use of CHO-K1 cells expressing human angiotensin II AT1 receptors Br J Pharmacol. 1999;126(4):1057-65. doi:10.1038/sj.bjp.0702398.

87. Le M.T., De Backer J.P., Hunyady L., et al. Ligand binding and functional properties of human angiotensin AT1 receptors in transiently and stably expressed CHO-K1 cells. Eur J Pharmacol. 2005;513 (1-2):35-45. doi:10.1016/j.ejphar.2005.02.029.

88. Van Liefde I., Vauquelin G. Sartan-AT1 receptor interactions: in vitro evidence for insurmountable antagonism and inverse agonism. Mol Cell Endocrinol. 2009;302(2):237-43. doi:10.1016/j.mce.2008.06.006.

89. Bhuiyan M.A., Ishiguro M., Hossain M., et al. Binding sites of valsartan, candesartan and losartan with angiotensin II receptor 1 subtype by molecular modeling. Life Sci. 2009;85(3,4):136-40. doi:10.1016/j.lfs.2009.05.001.

90. Minatoguchi S., Aoyama T., Kawai N., et al. Comparative effect of candesartan and amlodipine, and effect of switching from valsartan, losartan, telmisartan and olmesartan to candesartan, on early morning hypertension and heart rate. Blood Press. 2013;22(Suppl. 1):29-37. doi:10.3109/08037051.2013.757844.

For citation:

Ostroumova O.D., Kochetkov A.I., Cherniaeva M.S. Arterial Hypertension in Older Adults in the Light of New European Guidelines 2018. Rational Pharmacotherapy in Cardiology. 2018;14(5):774-784. (In Russ.)

Views: 939

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

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)