Hypertension in the older patient

The increased prevalence of hypertension in the elderly should not be considered a normal consequence of aging. The majority of older patients have elevated systolic blood pressure. The risk of developing coronary disease and heart failure increases as the systolic blood pressure increases, but antihypertensive treatment is successful in lowering the risk of cardiovascular and cerebrovascular disease. Despite the documented success of antihypertensive therapy in treating hypertension in clinical trials, the reality is that in the general population, the control of hypertension is very inadequate. The most recent National Health and Nutrition Examination Survey (NHANES) found that only 27.4% of the hypertensive population has blood pressure controlled to 140/90 mm I-Ig or less; The Sixth Report of the Joint National Committee on the Detection, Awareness, and Treatment of Hypertension (JNC-VI) addresses these problems and provides guidelines for management. A major management emphasis advocated in JNC-VI is stratifying patients into risk groups according to overall cardiovascular risk and the presence of target organ damage. Lifestyle modifications are stressed for all patients with hypertension, and diuretics and long-acting calcium channel blockers are endorsed as appropriate first-line agents in older patients with isolated systolic hypertension. The report also provides compelling indications for the use of certain drugs, advocates use of long-acting agents in order to increase compliance, and recommends use of low-dose drug combinations that can increase efficacy and safety, all important considerations in the older patient with hypertension. The role of hypertension specialists in managing difficult-to-treat cases is also stressed. Systolic hypertension in the elderly is a disease that confers significant cardiovascular risk. Several treatment options are available for managing isolated systolic hypertension and to decrease cardiovascular morbidity and mortality.