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1. Introduction
Many elderly are treated with several different drugs. With an increase in the number of medicines, there is a greater risk of interactions and adverse effects. There are however also risks associated with the underuse of recommended treatment. For several diseases, it has been shown that it is more common for elderly than for younger patients to receive suboptimal treatment with the recommended drugs [1–3]. Regional guidelines for the treatment of cardiovascular diseases, built on evidence based data, should in most cases be followed also in the diagnosis and treatment of elderly [4].
Hypertension is a well-documented risk factor for cardiovascular disease. There is strong evidence that elderly benefit from antihypertensive treatment at least as much as younger do, probably due to higher risk for cardiovascular events [5]. The recommendation is a target blood pressure (BP) of 130/80 for patients with diabetes and of 140/90 for others [4]. However, recent research has shown that lower systolic blood pressure (SBP) seems to be associated with greater mortality in patients aged 85 or more, irrespective of health status. An optimal SBP for this age group could be above 140 mmHg [6].
The recommendation for ischemic heart disease is treatment with aspirin, beta-blocker, and, if the cholesterol level is above recommended, also statin [4]. There is evidence for lowered mortality and morbidity using such treatment, even if only a small number of patients in studies about coronary disease are more than 75 years old.
For the diagnosis heart failure, cardiac dysfunction has to be objectively confirmed. The recommended method is echocardiography (ECO). Recommended pharmacological therapy for heart failure is angiotensin converting enzyme inhibitors (ACEIs) which have a well-established effect on mortality and morbidity [4, 7] and for NYHA (New York Heart Association) functional class II-IV also beta-blockers. NYHA functional classification grades the severity of heart failure symptoms. Unfortunately ACEIs are often underused for older patients and especially in nursing homes [2]. Diuretics are overused instead.
For patients with chronic atrial fibrillation, anticoagulation should be given to lower the risk of stroke [4]. This risk is depending on age and comorbidity and can be calculated with the CHADS2 score, giving one point each for the presence of congestive heart failure, hypertension, age 75 years...