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Hypertension in the elderly

Gary E Sander1

  • 1Department of Medicine, Section of Cardiology, Louisiana State University Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA. gsande@lsuhsc.edu

Current Hypertension Reports
|November 6, 2004
PubMed

Insights

High blood pressure in older adults is not normal aging but a treatable condition. Aggressive treatment of isolated systolic hypertension reduces cardiovascular events, with careful monitoring for side effects.

Area of Science:

  • Cardiology
  • Geriatrics
  • Hypertension Research

Background:

  • High blood pressure (hypertension) was once considered a normal part of aging.
  • It is now understood to stem from aortic structural and physiological abnormalities.
  • Elevated systolic blood pressure and pulse pressure significantly increase risks for stroke, myocardial infarction, and heart failure.

Purpose of the Study:

  • To review the current understanding of hypertension in the elderly.
  • To emphasize the importance of treating isolated systolic hypertension.
  • To discuss treatment strategies and agent selection for elderly hypertensive patients.

Main Methods:

  • Review of clinical trial data on hypertension treatment efficacy.
  • Analysis of cardiovascular event rates in treated versus untreated hypertensive individuals.
  • Discussion of guidelines and expert recommendations for antihypertensive therapy in older adults.

Main Results:

  • Clinical trials confirm that hypertension treatment significantly reduces cardiovascular event rates.
  • Isolated systolic hypertension (systolic blood pressure ≥ 140 mm Hg, diastolic < 90 mm Hg) is prevalent in individuals aged 60 and older.
  • Controversy persists regarding optimal antihypertensive agents and combinations.

Conclusions:

  • Elderly patients with hypertension should be treated aggressively to achieve target blood pressures comparable to younger patients.
  • Initiating treatment with lower doses and slower titration is recommended to monitor for adverse effects like orthostatic hypotension, cognitive impairment, and electrolyte disturbances.

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