Prevalence and prognostic significance of hypertension in the elderly

Understanding the problem of hypertension in the elderly calls not only for an understanding of the physiologic phenomenon involved, but of the statistics currently available pertaining to this widespread disorder. In the age group 60 to 69 years, more than 25% of the population screened by the Hypertension Detection and Follow-Up Program (HDFP) had isolated systolic hypertension; ie, a systolic blood pressure greater than or equal to 140 mmHg with a diastolic blood pressure less than 90 mmHg. Setting the criterion for definition at a systolic blood pressure greater than or equal to 160 mmHg, the prevalence in this age group was almost 10%. Prevalence of diastolic hypertension, ie, diastolic blood pressure greater than or equal to 90 mmHg in this age group was more than 40%. Data from that same study show also that elevated systolic blood pressure in the face of a normal diastolic blood pressure was associated significantly with increased mortality. In the HDFP, stepped-care treatment reduced the five-year incidence of fatal and nonfatal stroke in these individuals by more than 50%. These results were achieved with minimum side effects. Reports of this kind surely will overcome the popular tendency to consider elevated blood pressure in the elderly as a natural phenomenon of aging and, hence, acceptable. There is nothing natural about hypertension in the elderly, nor should it be acceptable. Because it is important to control hypertension before it can cause end-organ damage, physicians are urged not to postpone treatment of hypertension in the elderly, but to initiate it promptly, keeping in mind the whole physiologic and psychosocial state of the elderly patient with hypertension.