MANAGING THE OLDER PATIENT WITH HYPERTENSION

In elderly patients, elevation of systolic blood pressure represents a more serious risk than elevation of diastolic blood pressure. Major trials of antihypertensive therapy in the elderly include the Systolic Hypertension in the Elderly Program, the Swedish Trial of Older Patients with Hypertension, the Medical Research Council Trial, and the Veterans Affairs Cooperative Study Group. Results of these trials indicate that, even for very elderly patients, reducing blood pressure reduces both morbidity and mortality from stroke and cardiac disease. Diuretics and calcium antagonists stand out as particularly efficacious in elderly hypertensive patients. Beta-Adrenergic blockers and angiotensin converting enzyme inhibitors may be less suitable in this patient population. Studies of the effects of antihypertensive therapy on the quality of life indicate that elderly patients can easily tolerate efficacious doses of antihypertensive drugs.