Hypertension in the elderly

The relation between hypertension, cerebrovascular disease, and heart failure in the elderly is well established. The concept that this was entirely due to hardening of the arteries and, therefore, an essential feature of aging has been revised in the last 15 years to show that there are groups of elderly people in whom hypertension is not a problem, and in this group stroke disease and heart failure are relatively uncommon. The treatment of hypertension in the elderly attracts increasing attention. The successful lowering of blood pressure in the elderly has now been reported by many authors with a variety of therapeutic agents. The case for treatment has been demonstrated in those up to 80 years of age by the European Working Party in Hypertension in the Elderly, and relevant data on compliance are also available in the older age group in the Sub-Group Analysis of the Hypertension Detection and Follow-up Programme. A similar reduction of blood pressure, both systolic and diastolic, can be safely achieved with thiazides, beta-blockade, calcium channel blockade, angiotensin-converting enzyme inhibitors, and centrally acting drugs. The differentiation between these groups is largely a matter of the side effects that occur and any concurrent existing illness from which the patient suffers, e.g., diabetes, bronchitis, heart failure, and so on. From the information available to date, the problem of choice of the most suitable drug remains a clinical decision for the prescribing doctor.