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Abstract(s)
A transição demográfica, caracterizada pela diminuição da taxa de natalidade e aumento da expetativa de vida, tem-se refletido no envelhecimento da população mundial.
O envelhecimento tem alterado o padrão epidemiológico das principais causas de morbilidade e mortalidade, aumentando a incidência de doenças crónicas. A hipertensão arterial é a doença crónica mais comum nos países desenvolvidos, constituindo um importante problema de saúde pública. A sua prevalência aumenta com a idade, decorrente de alterações estruturais e funcionais que ocorrem com o envelhecimento.
A maioria dos idosos são hipertensos. A hipertensão arterial é o principal fator de risco modificável de morbilidade e mortalidade cardiovascular. Associa-se a complicações em órgãos vitais e ao nível dos vasos sanguíneos, destacando-se o acidente vascular cerebral, os eventos coronários, a insuficiência cardíaca, a doença renal, a doença arterial periférica e o comprometimento cognitivo. Estas lesões de órgão-alvo são altamente prevalentes no idoso e estão associadas ao inadequado controlo da pressão arterial, consequência da frequente coexistência de fatores de risco adicionais e da multipatologia comum nesta faixa etária.
Um estilo de vida saudável ajuda a gerir a hipertensão, com benefícios que vão além da redução da pressão arterial, agindo sobre o risco cardiovascular total.
Várias classes de anti-hipertensivos são eficazes na prevenção de eventos cardiovasculares. Em idosos nos quais o tratamento farmacológico está indicado as decisões de tratamento devem ser guiadas pela presença de indicações e contra-indicações baseadas na coexistência de outras co-morbilidades, bem como pela tolerabilidade individual à monoterapia ou combinações de fármacos. Em idosos, os limiares de diagnóstico e metas de pressão arterial podem ser menos rigorosos, principalmente após os 80 anos.
No idoso hipertenso com multipatologia o tratamento da hipertensão deve ser individualizado e estudos adicionais são necessários para avaliar a estratégia terapêutica ideal. Deste modo, esta dissertação pretende rever as bases teóricas da hipertensão arterial, tendo como principal objetivo conhecer as co-morbilidades mais frequentes no idoso hipertenso e compreender como é que a idade e a multipatologia associada interferem na abordagem terapêutica anti-hipertensora.
The demographic transition, characterized by declined birth rates and increased life expectancy, has been reflected in the aging of the world's population. Aging has changed the epidemiological pattern of the major causes of morbidity and mortality, increasing the incidence of chronic diseases. Hypertension is the most common chronic disease in developed countries, being an important public health problem. Its prevalence increases with age, due to structural and functional changes that occur with aging. Most of the elderly are hypertensive. Hypertension is the main modifiable risk factor for cardiovascular morbidity and mortality. It is associated with complications in vital organs and at the level of blood vessels, including stroke, coronary events, heart failure, kidney disease, peripheral arterial disease and cognitive impairment. These target organ lesions are highly prevalent in the elderly and are associated with inadequate blood pressure control, as a consequence of the frequent coexistence of additional risk factors and multiple comorbidities in this age group. A healthy lifestyle helps hypertension management, acting on total cardiovascular risk, with benefits extending beyond lowering of blood pressure. Several classes of antihypertensive drugs are effective in preventing cardiovascular events. In elderly patients in whom pharmacological treatment is indicated, treatment decisions should be guided by the presence of indications and contraindications based on other co-existing comorbidities, as well as individual tolerability of monotherapy or drug combinations. In the elderly, diagnostic thresholds and blood pressure targets may be less stringent, especially after age 80. In the hypertensive elderly with multipathology the treatment of hypertension should be individualized and further studies are needed to assess the optimal treatment strategy. Thus, this thesis aims to review the theoretical bases of hypertension, focusing on getting to know the most frequent comorbidities in the hypertensive elderly and to understand how age and associated multipathology interfere in the antihypertensive therapeutic approach.
The demographic transition, characterized by declined birth rates and increased life expectancy, has been reflected in the aging of the world's population. Aging has changed the epidemiological pattern of the major causes of morbidity and mortality, increasing the incidence of chronic diseases. Hypertension is the most common chronic disease in developed countries, being an important public health problem. Its prevalence increases with age, due to structural and functional changes that occur with aging. Most of the elderly are hypertensive. Hypertension is the main modifiable risk factor for cardiovascular morbidity and mortality. It is associated with complications in vital organs and at the level of blood vessels, including stroke, coronary events, heart failure, kidney disease, peripheral arterial disease and cognitive impairment. These target organ lesions are highly prevalent in the elderly and are associated with inadequate blood pressure control, as a consequence of the frequent coexistence of additional risk factors and multiple comorbidities in this age group. A healthy lifestyle helps hypertension management, acting on total cardiovascular risk, with benefits extending beyond lowering of blood pressure. Several classes of antihypertensive drugs are effective in preventing cardiovascular events. In elderly patients in whom pharmacological treatment is indicated, treatment decisions should be guided by the presence of indications and contraindications based on other co-existing comorbidities, as well as individual tolerability of monotherapy or drug combinations. In the elderly, diagnostic thresholds and blood pressure targets may be less stringent, especially after age 80. In the hypertensive elderly with multipathology the treatment of hypertension should be individualized and further studies are needed to assess the optimal treatment strategy. Thus, this thesis aims to review the theoretical bases of hypertension, focusing on getting to know the most frequent comorbidities in the hypertensive elderly and to understand how age and associated multipathology interfere in the antihypertensive therapeutic approach.
Description
Keywords
Co-Morbilidades da Hipertensão Hipertensão Arterial Idoso Risco Cardiovascular Tratamento Anti-Hipertensor