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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

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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.

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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.