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Review
. 2008 Jan;10(1 Suppl 1):33-9.
doi: 10.1111/j.1524-6175.2007.08030.x.

Hypertension control in the elderly

Joel M Neutel  1 , Lawrence I Gilderman
Affiliations
Review

Hypertension control in the elderly

Joel M Neutel et al. J Clin Hypertens (Greenwich). 2008 Jan.

Abstract

Hypertension is highly prevalent in older persons and most often presents as isolated systolic hypertension. Systolic blood pressure (BP) is a stronger predictor of risk than diastolic BP in persons older than 50 years. Most of these patients will require multiple drug therapies to achieve the substantial reductions in systolic BP needed to reach target levels. Clinical trials have demonstrated that antihypertensive therapy with beta-blockers and diuretics as well as with calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type 1 receptor blockers reduces cardiovascular risk in older patients. Studies examining safety and BP-lowering efficacy have shown that a renin-angiotensin-aldosterone system blocker plus a calcium channel blocker as well as a combination of diuretics and beta-blockers or diuretics plus an angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor blocker achieves greater BP reductions than monotherapy. Such multiple drug regimens are well tolerated in older patients.

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Figures

Figure 1
Figure 1
Effects of antihypertensive therapy in older patients with isolated systolic hypertension: summarized results of 8 trials. The analysis included 15,693 patients with median follow‐up of 3.8 years. T indicates treatment; C, control. Reprinted with permission from Staessen et al. 4
Figure 2
Figure 2
Change from baseline in (A) mean sitting systolic blood pressure (SBP) and (B) mean sitting diastolic blood pressure (DBP) (mm Hg) at the end of study 2 in elderly (65 years and older) patients. The number of patients in each treatment group ranged from 51 to 70. The reductions in blood pressure with combination therapy were not statistically significant compared with monotherapy. Reprinted with permission from Smith et al. 46
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