Treatment of hypertension in the elderly

Since 1967, results from well controlled long term studies have provided convincing evidence of the benefit of antihypertensive therapy in middle-aged patients. However, many physicians have hesitated to apply these findings to patients over 60 years of age. Recently, the results of several prospective randomised long term trials investigating the treatment of hypertension in elderly patients have been published. An analysis of the results of 5 major trials shows that antihypertensive treatment reduces overall mortality by 20%, cardiovascular mortality by 33%, the incidence of fatal and nonfatal cerebrovascular events by 40%, and complications as a result of coronary heart disease (i.e. fatal and nonfatal myocardial infarction and sudden cardiac death) by 15%. On the basis of trials undertaken in elderly patients with either high systolic and diastolic blood pressure or isolated systolic hypertension, antihypertensive therapy was more beneficial, in absolute terms, in elderly patients than in middle-aged patients with mild hypertension. Treatment was withdrawn as a result of adverse effects in about 2% of middle-aged and elderly hypertensive patients per year. Therefore, it is clear that elderly hypertensive patients should be treated.