Systolic hypertension in older persons

Area of Science:

• Gerontology
• Cardiology
• Pharmacology

Background:

• Systolic hypertension (SH) is a significant concern in individuals aged 60 years and older.
• The Seventh Report of the Joint National Committee defines SH as systolic blood pressure (SBP) ≥140 mm Hg with diastolic blood pressure <90 mm Hg.

Purpose of the Study:

• To conduct a systematic literature review on the clinical management of systolic hypertension in older populations.
• To evaluate the evidence supporting antihypertensive therapies for SH in elderly individuals.

Main Methods:

• A comprehensive MEDLINE search was performed for English-language literature published between 1966 and 2004.
• The search focused on studies of SH in older persons, prioritizing randomized clinical trials.
• 1064 studies were selected using keywords: hypertension, systole (or systolic), and aged.

Main Results:

• Strong clinical trial evidence supports treating SH in older adults with SBP ≥160 mm Hg.
• Limited large-scale trials exist for SBP between 140-159 mm Hg; recommendations rely on observational data showing a graded cardiovascular risk.
• Thiazide diuretics and long-acting calcium channel blockers are identified as preferred first-line therapies for SH.

Conclusions:

• Treatment of SH in older patients with SBP ≥160 mm Hg is well-supported by robust evidence.
• The evidence for treating SH to SBP levels of 140 mm Hg or in the 140-159 mm Hg range is less conclusive.
• Treatment decisions for SH in the 140-159 mm Hg range should prioritize patient preferences and tolerance.