[Arterial hypertension in very old people. Problems of treatment]

Several epidemiological tests showed that, in the very old, low blood pressure was associated with higher mortality and hypertension with a longer life. But more recent studies, some from our school, and the data from Framingham have clarified that the higher mortality in the very old with low blood pressure is to be attributed to pre-existing pathologies which caused the low blood pressure in the first place. Though specific intervention trials on the very old are not available, the analyses of the results of antihypertensive therapy in the sub-groups of the very old in some trials carried-out with elderly hypertensives suggest the use of pharmacological treatment also in the very old (> 80 yrs), at least for isolated systolic hypertension. The therapy must be based on a careful choice of drugs and carried-out with particular caution to avoid disability from hypertension as well as to avoid side effects which worsen the quality of life of your very old patients.