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Hypertension in Older Persons

William C. Cushman1, Henry R. Black

  • 1Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, TN.

Journal of Clinical Hypertension (Greenwich, Conn.)
|June 21, 2001
PubMed

Insights

Antihypertensive drug treatment effectively reduces cardiovascular risk in older adults with hypertension. However, achieving target blood pressure (BP) goals remains challenging, with fewer than 25% of patients controlled despite available therapies.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Hypertension, particularly elevated systolic blood pressure (SBP), significantly elevates cardiovascular risk in older individuals.
  • Antihypertensive drug therapy has proven effective in reducing cardiovascular events and mortality in this demographic.
  • Lifestyle modifications can aid blood pressure (BP) reduction, but pharmacologic intervention is typically required.

Purpose of the Study:

  • To review the efficacy and challenges of antihypertensive treatment in older populations.
  • To outline recommended therapeutic strategies for managing hypertension in elderly patients.
  • To emphasize the importance of achieving target BP goals for cardiovascular risk reduction.

Main Methods:

  • Review of controlled trials on antihypertensive drug treatment in older persons.
  • Analysis of lifestyle modifications and pharmacologic interventions for BP control.
  • Evaluation of specific drug classes for hypertension management in the elderly, including diuretics, calcium antagonists, ACE inhibitors, and beta-blockers.

Main Results:

  • Antihypertensive drug treatment demonstrably lowers cardiovascular events and mortality in older hypertensive patients.
  • Target BP goals are generally <140/90 mm Hg, or <130/85 mm Hg for diabetics.
  • Achieving target BP levels is difficult in many individuals over 65.
  • Initial treatment for most older hypertensives should involve low-dose diuretics or diuretic-based regimens.
  • Long-acting dihydropyridine calcium antagonists are suitable for isolated systolic hypertension (ISH) when diuretics are ineffective or not tolerated.
  • ACE inhibitors, beta-blockers, and diuretics are effective in reducing cardiovascular events in older hypertensive diabetic patients.
  • Multiple drug therapies are often necessary for effective BP management.
  • Less than 25% of older hypertensive patients achieve controlled BP levels despite available treatments.

Conclusions:

  • Effective antihypertensive drug therapies exist for older adults, reducing cardiovascular risk.
  • Achieving target blood pressure remains a significant clinical challenge in the elderly population.
  • A combination of pharmacologic agents and adherence to treatment protocols is crucial for optimal outcomes in older hypertensive patients.

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