Clinical care of the aging hypertensive patient

That elderly hypertensive patients need to be treated is now well established, as major clinical trials have confirmed the reduction in serious complications and organ damage in the treated patient. However, the concomitant findings on the high rates of adverse side effects of drug therapies to lower blood pressure are of concern. The physiologic and disease changes that occur with aging may explain some of the adverse drug responses encountered in this population. Nondrug treatment of hypertension, including sodium restriction and weight reduction, would be desirable in the elderly, but there are no trials of the efficacy and safety of these methods in this population. Homeostatic fragility in the elderly is the loss of the ability to regulate cardiovascular and respiratory function, and fluid and electrolyte balance under conditions of stress. Introduction of antihypertensive agents with their global effects on these homeostatic processes leads to frequent complications such as orthostatic hypotension, cardiac depression, reduced cerebral blood flow, and abnormalities in metabolic, volume, and electrolyte control. Although these adverse reactions explain some of the compliance problems in the elderly, several psychosocial factors also hinder the ability of older patients to follow therapeutic protocols. The need for alternative and more appropriate therapies tailored to fit these problems associated with aging is the desired goal of future blood pressure intervention policies.