Treatment of hypertension in the elderly

Abstract Investigation of preventive measures for hypertenslon and atherosclerosis is a geriatric medicine priority. While the causes of both isolated systolic hypertension and conventional systolic and diastolic hypertension in the elderly are well defined, the benefits of lowering blood pressure are not. Evidence to support the treatment of symptomatic hypertension is convincing for men 60 years of age; it is not for women in this age group. The need to treat hypertension, particularly isolated systolic hypertension in patients above 75 years old, is still not resolved. Isolated systolic hypertension in older patients is at least as strong a risk factor for cardiovascular disease as is diastolic hypertension. 0ngoing trials may answer these questions; do the meantime, drug therapy in this group will vary widely. The elderly hypertensive is more likely than the younger hypertensive to have other diseases; diagnosis of these disorders is crucial. Hypertension arising do novo late in life warrants a search for underlying and possibly remedial causes. Antihypertensdve drug therapy to relieve symptoms is difficult to jusf, because most elderly hypertensive patients are asymptornatic; however, it has been shown to delay morbid and fatal complications of hypertension. Appropriate therapy for the elderly hypertensive must be individualized and should be associated with few or no side effects. The thiazides are the preferred diuretics for long-term treatment of hypertension in the elderly. Beta blockers are attractive because they are cardliprotective, counter the end organ effect of catecnolamines and reduce angina; however, some decrease cardiac output, increase peripheral resistance, decrease renal blood flow and cause fatigue. These latter effects are not seen with the β blockers that possess the physiologic property intrinsic sympathomimetic. activity (ISA), which provides both blockade of the β adrenoceptor and weak stimulation of effector cells. The clinical significance of ISA can have particular benefits for elderly patients; the hemodynamic: characteristics of the ISA drugs make them a good choice for elderly hypertensives with left ventricular dysfunction, bradyarrhythmias or peripheral vascular disease. Calcium-channel blocking drugs effectively lower blood pressure in elderly hypertensives, however, they are not currently approved by the FDIC for hypertension. Converting enzyme inhibitors effectively lower blood pressure in elderly patients, particularly when combined with diuretics. Centrally acting drugs are effective antihypertensive agents in the elderly, particularly when used with a diuretic; methyldopa is the least appropriate. Hydralazine, although it produces tachycardia and may increase cardiac work, is an established second or third step drug.