Perspectives on treating hypertension in old age : the burden of polypharmacy, risks of treatment and GPs’ treatment probability

Streit, Sven R (2018). Perspectives on treating hypertension in old age : the burden of polypharmacy, risks of treatment and GPs’ treatment probability. (Dissertation, Leiden University, Faculty of Medicine, Leiden University Medical Center (LUMC))

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With increasing age, blood pressure (BP) rises as a consequence of arterial stiffness. It has been debated whether it is beneficial to treat hypertension in old age especially in >75-year-olds when they have multimorbidity, polypharmacy or frailty. Large trials showed that lowering BP in >60-year-olds is beneficial and lowers the risk for myocardial infarction, stroke and all-cause mortality. However, these trials lack generalizability and typically excluded multimorbid patients that are frail. At the same time, observational studies rose concerns about lowering BP too much since there are several cohort studies showing a reverse association of low BP and increased mortality especially in >75-year-olds. The general aim of this thesis is to increase the scientific knowledge about the effects of treating hypertension in >75-year-olds with frailty. This thesis has three aims: 1) to measure the prevalence of polypharmacy in older patients; 2) to test for an association between low SBP and mortality, cognitive function, daily functioning, and QoL in older patients under antihypertensive treatment; and 3) to understand the role that frailty plays in GP decisions about treating hypertension in old age across countries and see if those differences can be explained by country-specific cardiovascular disease burden and life expectancy.

Item Type:

Thesis (Dissertation)


04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Streit, Sven


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services


[4] Swiss National Science Foundation




Doris Kopp Heim

Date Deposited:

14 Apr 2020 15:05

Last Modified:

26 May 2020 15:54

Uncontrolled Keywords:

Hypertension Old age Frailty Multimorbidity Polypharmacy Cognition




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