[Hypertension in the elderly: particularities and precautions]

Hypertension is very common and inadequately controlled among the elderly. The HYVET study showed that antihypertensive therapy significantly reduces total mortality and cardiovascular events in people aged 80 years and older. The therapeutic goal for patients aged from 60 to 80 years is systolic blood pressure (SBP) less than 140 mmHg and a diastolic blood pressure (DBP) less than 90 mmHg, without orthostatic hypotension. For patients older than 80 years, the aim is keep SBP < 150 mmHg. This goal also depends on comorbidities, iatrogenic risk, and life expectancy. The choice of treatment must be adapted to the patient's clinical situation, taking into account any cardiovascular diseases, organ damage, and comorbidities. All of the principal antihypertensive drugs can be used in the elderly, with a preference for thiazide diuretics or calcium channel blockers for those with systolic hypertension. Generally, no more than three antihypertensive drugs should be prescribed for octogenarians (including a thiazide diuretic). Particular attention must be paid to the renal risk (estimated by glomerular filtration rate), especially for nephrotoxic and multiple drugs. Blood levels of potassium, sodium, and creatinine must be monitored in patients receiving diuretics or renin angiotensin system blockers, particularly during acute events (e.g., fever, infection, dehydration, and diarrhea). Cognitive function should be assessed in patients with hypertension older than 80 years, with the MMSE (Mini-Mental-State-Examination) to assess the risk of poor adherence, in view of the increased risk of dementia.