Hypertension: special concerns in managing the older patient

In most populations, average diastolic BP increases with age until the sixth decade and then remains constant, whereas average systolic BP continues to rise. Many studies have shown an increase in cardiac and stroke risk with increasing BP, even in elderly populations. Antihypertensive therapy in the elderly has been shown to reduce the risk of nonfatal and fatal stroke, nonfatal and fatal coronary heart disease, and all-cause mortality. The right combination of diet and lifestyle changes can help to control hypertension and reduce cardiovascular risk. For optimal results, give the patient as much informed choice as possible in the selection of therapies and setting of goals. Proceed cautiously when it is necessary to add pharmacologic therapy, whatever agent is chosen.