Do We Need Drug Therapy to Manage Mild Hypertension in the Elderly?

Mild hypertension (grade 1 or stage 1 hypertension) is defined as a systolic blood pressure of 140–159mm Hg or a diastolic pressure of 90–99mm Hg. According to current guidelines, patients with mild hypertension can be at low, medium, high or very high risk depending on the presence of other risk factors, target organ damage and associated cardiovascular or renal conditions. Guidelines recommend prompt initiation of antihypertensive treatment in patients at very high risk because of associated clinical conditions and this recommendation is strongly supported by the literature. Also patients at high risk must be treated without much delay, but it should be mentioned that the evidence is stronger for patients who are at high risk because of diabetes mellitus, than for patients at high risk because of left ventricular hypertrophy or the accumulation of ≥3 other risk factors.