Treatment of the older hypertensive: paradigms, practices, and proofs

Recent outcome trials in patients above age 60 with systolo-diastolic hypertension are reviewed. The meta-analysis suggests that antihypertensive drug therapy can decrease cardiovascular and coronary mortality in selected patients. Based on these studies it is suggested that antihypertensive drug therapy is indicated in patients between age 60 and 75 when the diastolic pressure remains above 95 mmHg after repeated measurements. A target for systolic b.p. is not definitely established but a pressure of 150 mmHg may serve as a temporary proposal. Whether uncomplicated isolated systolic hypertension in symptomless patients should be treated is still under investigation.