Managing the elderly hypertensive patient beyond blood pressure reduction

ANTIHYPERTENSIVE TREATMENT OF THE ELDERLY: Several prospective, randomized, long-term trials on antihypertensive drug treatment have shown that elderly patients with systolic and diastolic or isolated systolic hypertension benefit from a reduction in blood pressure. Antihypertensive treatment reduces the overall mortality by 20%, cardiovascular mortality by 33%, the incidence of fatal and non-fatal cerebrovascular events by 40% and the complications of coronary heart disease by 15%. In addition, elderly patients have a high risk of overt or latent and asymptomatic cardiovascular diseases. For this reason, not only antihypertensive treatment, but also risk factor modification (such as cholesterol reduction therapy) is, in absolute terms, more beneficial in elderly patients than in middle-aged patients, particularly in patients with concomitant cardiovascular diseases and other risk factors.

Although the randomized trials have focused on mortality and morbidity as main endpoints, it is questionable whether longevity is a worthwhile social objective in itself. Quality of life is an important aspect of antihypertensive treatment, since hypertension is generally symptomless while drug therapy may have adverse effects on the quality of life. The frequency of adverse effects is similar in both middle-aged and elderly hypertensive patients, with about 2% of patients per year in both age groups withdrawing from randomized treatment due to objectively assessed adverse effects. The rate of subjectively assessed adverse effects during treatment is also similar in younger and elderly patients. In general, clinical studies have suggested that a blood pressure reduction does not influence the well-being of elderly patients, whether measured in physical, emotional or social terms. Both calcium antagonists and diuretics have shown an age-dependent effect in comparative trials, with a higher blood pressure reduction in elderly than in younger patients.

Antihypertensive therapy in elderly hypertensives adds longevity and need not compromise quality of life. Although the reduction and normalization of blood pressure is the primary goal, the increased availability of antihypertensive preparations and drugs for treating concomitant diseases and risk factors allows the physician to tailor treatment of the elderly to the needs of the individual patient.