Time Trends in High Blood Pressure Control and the Use of Antihypertensive Medications in Older Adults

Abstract

IN THE mid-20th century, control of high blood pressure (BP) was initially defined as control of diastolic BP. The early clinical trials used diastolic BP alone as entry criteria.^1-3 The impressive results of these early trials focused attention on diastolic BP, while elevations of systolic BP were thought to accompany old age as a normal process.⁴ At the time, students of medicine were taught that age plus 100 provided an estimate of the "normal" systolic BP in older adults. In the last 15 years, interest in systolic BP has become more pronounced. Analysis of data from subjects screened for the Multiple Risk Factor Intervention Trial⁵ drew attention to the importance of systolic BP even in middle-aged adults. More recently, the treatment of isolated systolic hypertension with low-dose diuretics was effective in preventing the devastating clinical complications of untreated high systolic BP.⁶ The Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC) first gave prominence to systolic BP only as recently as 1993.⁷ In 2000, the JNC issued a clinical advisory statement on the importance of systolic BP in older Americans.⁸