Management of systolic hypertension in the elderly

This article addresses management of hypertension in the elderly, with a specific focus on systolic hypertension wherever data are available. Validity of office and home blood pressure readings is discussed with attention to a variety of measurement artifacts in the elderly. The efficacy of lifestyle modifications is summarized. The 1994 recommendation (of the National High Blood Pressure Education Program Working Group on Hypertension in the Elderly) to begin antihypertensive drug therapy with low doses of a thiazide or thiazide-like diuretic is defended. Guidelines also are provided for the safe use of alternate or second-line drugs including the beta-blockers, calcium antagonists, and angiotensin converting enzyme inhibitors.