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Wilbert S. Aronow, M.D., Cardiology Division, New York Medical College, Valhalla, NY, USA
Hypertension is present in 64% of elderly men and in 78% of elderly women. Hypertension in elderly persons is characterized by an increased systolic blood pressure (SBP) with a normal or low diastolic blood pressure (DBP). Hypertension is a major cardiovascular risk factor and is present in 69% of persons with a first myocardial infarction, in 77% of persons with a first stroke, in 79% of persons with chronic heart failure, and in 60% of elderly persons with peripheral arterial disease. Randomized controlled trials have demonstrated that antihypertensive drugs significantly reduce cardiovascular outcomes in elderly persons. Blood pressure is adequately controlled in 36% of men and in 28% of women aged 60-79 years and in 38% of men and in 23% of women aged =80 years. Nonpharmacologic lifestyle measures should be used to treat elderly persons with hypertension. Antihypertensive drug therapy should be used in persons aged 60-79 years with a SBP = 140 mm Hg or a DBP =90 mm Hg and in persons aged =80 years with a SBP =150 mm Hg. Diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, and calcium channel blockers have all significantly reduced cardiovascular outcomes in elderly persons with hypertension. Initiation of antihypertensive drug therapy in the elderly should generally be at the lowest dose with gradual increments as tolerated. A therapeutic target of < 140/90 mm Hg in persons aged 60-79 years and a SBP of 140-145 mm Hg if tolerated in persons aged =80 years is reasonable.
