Hypertension in the Elderly

Abstract

Both systolic and diastolic blood pressure increase with advanced ageand more than 50% of hypertensive patients are aged above 65years. Age-related vascular and neuro-humoral changes are importantfactors leading to the development of hypertension in the elderly andthe increase in systolic and diastolic blood pressure with age in anyindividual is a consequence of the relative change in arterialresistance and stiffness. Therefore, hypertension is predominantly orpurely systolic in the elderly both in women and men. The risks ofhypertensive patients over the age of 65 years are significant andseveral trials have provided compelling evidence that treatment ofhypertension in the elderly is beneficial in terms of reduced morbidityand mortality. Goal blood pressure should be similar in older andyounger patients. Lifestyle modifications are of proven benefit and maybe the only therapy needed for stage 1 hypertension. The Sixth report ofthe JNC recommends diuretics, specifically thiazide diuretics as theinitial choice for the treatment of elderly patients without anycomorbid conditions. Beta-blockers are less effective than thiazides asfirst line treatment and may only reduce stroke events. Recently,dihydropiridine calcium antagonists have been advocated as first choiceagents for the treatment of hypertension in the elderly and are suitablealternatives when diuretics are ineffective, contraindicated or nottolerated. Newer drugs such as AT1 antagonists are also effective inlowering blood pressure in the elderly but large scale data concerningtheir protective effects are still lacking.