A review of hypertension in the elderly.

The purpose of the paper is to review available information on hypertension in the elderly. Study design applicability of the results to management of patients at risk. Although systolic blood pressure is the strongest cardiovascular risk factor in the elderly, diastolic blood pressure continues to be an independent risk predictor. Structural changes in the major vessels play a predominant role in the pathogenesis of hypertension in the elderly. Such changes include a decrease in aortic compliance and atherosclerosis. The most consistent cardiovascular physiologic change in elderly patients with hypertension is increased peripheral resistance. The most appropriate anti-hypertensive agent would decrease peripheral resistance by relaxing vascular smooth muscle or by blocking the peripheral alpha-adrenergic system. It is concluded that a review of the pathophysiologic mechanisms of hypertension in the elderly will guide physicians in making appropriate treatment decisions.