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Treatment of hypertension in the elderly
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-8852.
Insights
Managing hypertension in the elderly requires careful consideration of diagnostic challenges and treatment approaches. While antihypertensive therapy benefits those with combined systolic and diastolic hypertension, evidence for isolated systolic hypertension is pending.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Hypertension is prevalent in the elderly, presenting unique diagnostic challenges such as pseudohypertension and orthostatic hypotension.
- Elderly hypertensive patients may experience specific physiological changes impacting blood pressure management.
Purpose of the Study:
- To review the diagnostic considerations and therapeutic strategies for hypertension in the elderly.
- To evaluate the current evidence for antihypertensive therapy in elderly individuals with different types of hypertension.
Main Methods:
- Review of existing clinical trial data on antihypertensive therapy in elderly populations.
- Discussion of diagnostic dilemmas and physiological characteristics relevant to elderly hypertensive patients.
Main Results:
- Antihypertensive therapy has demonstrated protection against cardiovascular complications in elderly patients with combined systolic and diastolic hypertension.
- Data on the efficacy of antihypertensive therapy for isolated systolic hypertension in the elderly are currently limited.
Conclusions:
- Cautious reduction of elevated systolic blood pressure is recommended for elderly patients with isolated systolic hypertension, pending further data.
- Non-drug therapies are safe and potentially effective; drug therapies should be used gradually, respecting the physiological fragility of the elderly.
Abstract:
Hypertension, both combined diastolic plus systolic and isolated systolic, is common in the elderly. Elderly hypertensive patients pose a number of diagnostic dilemmas, including pseudohypertension, postural and postprandial decreases in blood pressure, and the potential for renovascular hypertension. Data from large clinical trials have documented protection from cardiovascular complications by antihypertensive therapy for elderly people with combined systolic and diastolic hypertension. However, no data are available concerning the value of therapy for those with isolated systolic hypertension. Until such data become available from the Systolic Hypertension in the Elderly Program in 1991, cautious reduction of elevated systolic blood pressure levels is recommended. The fragile physiologic characteristics of the elderly demand caution and gentleness in the use of any therapy to lower blood pressure. Nondrug therapies are safe and may be effective. A variety of drugs are available and can be used to gradually reduce blood pressure to presumably safer levels.