Special management needs of the elderly hypertensive patient

Cardiovascular (CV) disease will progressively assume greater importance as the number of elderly, individuals in the population of the world increases with a parallel increase in the incidence of hypertension. Elderly patients with hypertension are often difficult to manage. Pathophysiological changes associated,with ageing are also associated with long-standing, uncontrolled hypertension. Diagnosis may not be straightforward and the incidence of concomitant disease will be higher than ill)younger patients. The preventative benefits of all hypertensive therapy in the elderly, is well established and treatment of hypertension is of greatest value in older patients who, because of additional risk factors or prevalent CV disease, are at a higher risk of developing a CV event. However, established benefits arc based upon the evidence from randomised, controlled trials in selected patient groups which may not be universally applicable to Many elderly hypertensives. Thus, the treatment of hypertension in the elderly should be based upon in individualised approach which inevitably cannot be strictly evidence-based. However, there is a compelling case for all approach based upon a recognition that high blood pressure (BP) in the elderly, should be treated earls, and vigorously whilst at the same time exercising some caution to avoid the development of hypotensive BP levels.