Impact of demographic trends on cardiovascular therapy during the next decade

The main demographic transition during the next decade will be a worldwide increase in older and elderly people, both in proportional and absolute terms. Although age itself is the main risk factor for morbidity and disability, additional cardiovascular risk may be brought about by inherent rises of blood pressure in these older age groups. This additional risk factor appears to be a suitable target for corrective measures. Recent therapeutic trials in mild or moderate hypertension all shared the common use of thiazides as one of the basic drugs of treatment. Subgroups of older hypertensives who were randomised to active treatment tended to fare better than those on placebo. This was mainly due to a reduction in cerebrovascular complications, but in the one trial where a potassium-sparing component was added to the thiazide, cardiac events were also reduced.