Hypertension in the elderly woman

Prevention, diagnosis and management

Abstract

Background: Hypertension is highly prevalent among women over 65 years old, representing a major risk factor for cardiovascular events and functional decline. Postmenopausal hormonal changes, together with comorbidities and frailty, contribute to isolated systolic hypertension and complicate management. Objective: To synthesize current evidence on clinical, hormonal, and geriatric factors influencing hypertension in older women and to propose evidence-based strategies for diagnosis, treatment, and adherence. Methods: A narrative review was conducted using PubMed, Scopus, and SciELO for studies published between January 2020 and June 2025. Search terms included “hypertension in older women”, “frailty and hypertension”, “renal function”, “polypharmacy”, “adherence to antihypertensive therapy”, and “polypill in elderly”. International guidelines, systematic reviews, cohort studies, and clinical trials were prioritized. Results: Accurate diagnosis requires attention to isolated systolic hypertension, blood pressure variability, and masked or white-coat hypertension. Ambulatory blood pressure monitoring and comprehensive geriatric assessment are essential. Treatment should be individualized, balancing cardiovascular risk reduction and safety while considering frailty, comorbidities, and polypharmacy. Fixed-dose combination therapy (polypill) improves adherence and blood pressure control without increasing adverse events. Conclusions: Management of hypertension in older women must be patient-centered and evidence-based. Integrating functional assessment, continuous monitoring, and optimized therapeutic strategies can reduce cardiovascular risk and enhance quality of life