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Managing hypertension in the elderly: dispelling the myths
1Department of Nephrology and Hypertension, Cleveland Clinic Foundation, OH 44195.
Insights
Treating high blood pressure in older adults is safe and effective. Evidence shows that managing both systolic and diastolic hypertension reduces cardiovascular risks without negatively impacting quality of life.
Area of Science:
- Gerontology
- Cardiology
- Clinical Pharmacology
Background:
- Over 31 million Americans are aged 65+, with at least half experiencing hypertension.
- The elderly population is projected to reach 16 million over age 85 by 2050.
Purpose of the Study:
- To review current data and recommendations for hypertension management in elderly patients.
Main Methods:
- Review of randomized clinical trials on hypertension treatment in older adults.
Main Results:
- Judicious treatment of elevated systolic and diastolic blood pressure significantly reduces cardiovascular morbidity and mortality.
- Treatment offers an acceptable trade-off regarding side effects and quality of life.
Conclusions:
- Randomized trials debunk myths about treating hypertension in the elderly.
- Low-dose diuretics are recommended as initial therapy for hypertension in older adults, unless contraindicated.
- Alternative antihypertensive agents should be considered when diuretics are not suitable.
Background:
There are now more than 31 million people 65 years of age or older in the United States, at least half of whom have systolic blood pressure 140 mm Hg or higher or diastolic blood pressure 90 mm Hg or higher or both. By the year 2050, 16 million Americans will be over age 85.
Objective:
To review the current data and recommendations regarding treating hypertension in elderly patients.
Summary:
Randomized clinical trials have dispelled some of the myths that surround treatment of hypertension in the elderly by showing that judicious treatment of elevated blood pressure, both systolic and diastolic, will reduce the risk of cardiovascular morbidity and mortality, with an acceptable trade-off in terms of side effects and without sacrificing quality of life.
Conclusions:
Because most of the trials have used a diuretic as initial therapy, it is recommended that one of these agents be prescribed in low doses if life-style modifications do not reduce blood pressure to acceptable levels, unless there is a contraindication to diuretics or an indication for another class of agents.