Rational for Treatment of Hypertension in the Elderly

Hypertension is a powerful predisposing factor to the major cardiovascular problems common to the elderly, doubling the risk. This increased risk of cardiovascular events exceeds that associated with the existence of hypercholesterolemia, diabetes, and smoking. The decrease in risk ratio with advancing age is offset by the increased cardiovascular disease incidence, resulting in a greater attributable risk, which makes treatment of hypertension more cost effective in the elderly. The prevalence of hypertension is high in the elderly, with about 50% afflicted; 65% of those patients have isolated systolic hypertension (ISH). Hypertension in the elderly often occurs concomitantly with hypercholesterolemia, diabetes, obesity, hypertriglyceridemia, and left ventricular hypertrophy, all of which enhance the risk. Also, 25% of these patients already have manifest cardiovascular disease. These associated cardiovascular conditions and risk factors determine the urgency for treatment and choice of optimal therapy. Antihypertensive trials indicate greater benefit of antihypertensive therapy in the elderly than in the young and have been shown to clearly benefit those with ISH. Thus, hypertension is dangerous in the elderly, is readily controlled, and treatment can provide great benefit in preventing cardiovascular sequelae.