Managing hypertension in the elderly: dispelling the myths
Donald G. Vidt, MD
Ray W. Gifford, MDAddress reprint requests to R.W.G., Department of Nephrology and Hypertension, A101, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
There are now more than 31 million people 65 years of age or older in the United States, at least half of whom have systolic blood pressure 140 mm Hg or higher or diastolic blood pressure 90 mm Hg or higher or both. By the year 2050, 16 million Americans will be over age 85.OBJECTIVE
To review the current data and recommendations regarding treating hypertension in elderly patients.SUMMARY
Randomized clinical trials have dispelled some of the myths that surround treatment of hypertension in the elderly by showing that judicious treatment of elevated blood pressure, both systolic and diastolic, will reduce the risk of cardiovascular morbidity and mortality, with an acceptable trade-off in terms of side effects and without sacrificing quality of life.CONCLUSIONS
Because most of the trials have used a diuretic as initial therapy, it is recommended that one of these agents be prescribed in low doses if life-style modifications do not reduce blood pressure to acceptable levels, unless there is a contraindication to diuretics or an indication for another class of agents.