Age-related issues in the treatment of hypertension

The highest prevalence of hypertension is now recognized to exist in the elderly segment of the population. With the completion of several large-scale studies, several of our assumptions regarding elderly hypertensive patients have changed. It is now clear that the elderly have shown the greatest benefit from antihypertensive therapy. This favorable risk-benefit ratio extends to even the very elderly; treatment for hypertension is appropriate for healthy elderly individuals, regardless of age. It also extends to elderly individuals who have already experienced the consequences of elevated blood pressure. Attitudes toward antihypertensive agents have also evolved. Diuretics are appropriate monotherapy in many patients, when the dose is kept low. The usefulness of calcium antagonists has been confirmed, whereas beta blocker use appears to be indicated only in certain subgroups. Recently, angiotensin-converting enzyme inhibitors have also been shown to be effective in elderly patients, despite earlier studies whose results describe low plasma renin activity in the elderly.