Treating Hypertension in the Elderly

Combination therapy – two drugs combined in a single pill – has the potential advantage of avoiding side effects associated with high doses of a single drug, while maximizing convenience and compliance.

Bottom Line

Hypertension should be treated in the elderly and very elderly similar to the manner in which it is addressed in younger patients. In most cases, target blood pressure should be the same, regardless of age: less than 140/90 mm Hg in patients with uncomplicated hypertension.

However, it is important to weigh quality of life issues carefully when treating older patients, because they are more susceptible to potential side effects and adverse outcomes. This is even more significant in the very elderly.

Overall, many of the same classes of medications that are used in younger patients are appropriate in the elderly. Treatment should begin at low doses, with cautious increases as needed. Thiazide diuretics are often an appropriate first choice, with medications from other classes added as required.

References

P Expert Consensus Document on Hypertension in the Elderly. J. Am. Coll. Cardiol. 2011;57:2037-114.

Dr. Clark is an associate director in the family medicine residency program at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.

This column, "Clinical Guidelines for Family Physicians," appears regularly in Family Practice News, a publication of Elsevier.