Why and How We Should Treat Elderly Patients with Hypertension?

Double-blind, randomized, placebo-controlled studies have documented that antihypertensive drug therapy decreases cardiovascular events in older persons. In the Hypertension in the Very Elderly Trial, patients aged 80 years and older treated with antihypertensive drug therapy had at 1.8-year follow-up, a 30% insignificant decrease in fatal or nonfatal stroke, a 39% significant decrease in fatal stroke, a 21% significant decrease in all-cause mortality, a 23% insignificant decrease in death from cardiovascular causes, and a 64% significant decrease in heart failure. The goal of treatment of hypertension in older persons is to decrease the blood pressure to <140/90 mm Hg and to <130/80 mm Hg in older persons with diabetes or chronic renal disease. Elderly persons with diastolic hypertension should have their diastolic blood pressure reduced to 80 to 85 mm Hg. There are no randomized controlled clinical trials supporting a target blood pressure of less than 130/80 mm Hg in elderly persons. The optimum diastolic blood pressure goal in elderly persons is unclear. Diuretics should be used as initial therapy in persons with no associated medical conditions. The selection of antihypertensive drug therapy in persons with associated medical conditions depends on their medical conditions. If the blood pressure is > 20/10 mm Hg above the goal blood pressure, drug therapy should be initiated with 2 antihypertensive drugs. Other coronary risk factors must be treated.