Hypertension in the Elderly

The available data indicate that classical hypertension, defined here as a diastolic blood pressure greater than or equal to 95 mm Hg, is a widely prevalent and as important a risk factor for the cardiovascular diseases in those aged 65 and over as it is in those under 65. The limited available data also indicate that pure systolic hypertension, defined here as a systolic blood pressure exceeding 160 mm Hg with a diastolic pressure under 95 mm Hg, also very common at age 65 and over, is also related to excess cardiovascular morbidity and mortality in the elderly. However, it is not clear whether this latter relationship is indicative of cause and effect, or merely reflects the fact that in the elderly pure systolic hypertension is a sign of extensive sclerosis of large arteries. The results of Veterans Administration studies on antihypertensive therapy indicate that the elderly patient with classical hypertension is amenable to effective treatment, and that the benefits of such treatment significantly outweigh the risks. Great care is needed in the use of drugs for the management of hypertension in elderly patients, especially to minimize risk of hypotensive episodes and their possible harmful consequences; but with judicious and careful therapy, hypertension of this type can be controlled with reduction in excess risk of morbidity and mortality, at least for those with average diastolic pressures greater than or equal to 105 mm Hg. The lack of data on the benefits of treatment for those with pure systolic hypertension precludes any recommendations in regard to pharmacologic treatment of this condition.