Hypertension in the elderly

Hypertension and its cardiovascular consequences are growing medical problems in the elderly. Hypertension in older patients is characterized not only by an increase in peripheral vascular resistance, but also by a reduction in arterial compliance. These abnormalities result in marked rises in systolic pressures and variable diastolic pressures that range from markedly elevated to low-normal. Several large placebo-controlled trials have recently demonstrated that treating hypertension in elderly patients reduces cardiovascular disease. This is true in patients with systolic and diastolic hypertension as well as patients with isolated systolic hypertension. Although reduction of cardiovascular end points has only been demonstrated for thiazide diuretics and beta-blockers, it may be reasonable to include other classes of medications in the initial treatment of some elderly hypertension patients.