Management of hypertension in older patients

Reduction of hypertension, whether systolic and diastolic or isolated systolic, is associated with significant reductions in mortality and morbidity rates even in older asymptomatic patients, particularly those less than 80 years old. The increased availability of antihypertensive preparations makes it possible to individualize the choice of therapy to meet the particular needs of the older patient. Although most presently available antihypertensive agents are effective, each one possesses different properties and none is free of side effects. We review the indications for and the action and side effects of diuretics, angiotensin converting enzyme inhibitors, calcium channel blockers, and adrenergic blocking drugs, and we offer treatment suggestions for hypertension associated with other diseases such as diabetes mellitus, heart failure, peripheral vascular insufficiency, depression, dementia, and urinary incontinence. Orthostatic hypotension is particularly serious in older patients because it may precipitate falls. It is also possible that the relationship between blood pressure levels and mortality and morbidity risks is not linear but J-shaped, both low and high levels increasing risks. Caution in treating hypertensive elderly patients will minimize the incidence of side effects.