Hypertension and the elderly.
Cardiovascular disease remains the major cause of death in elderly people, with hypertension the main treatable risk factor. Despite this there has been little consensus with regard to assessment or treatment of the elderly hypertensive patient. Several recent large intervention trials have shown blood pressure (BP) reduction in elderly patients with combined and isolated systolic hypertension using thiazide diuretics or beta-blockers significantly reduces cardiovascular morbidity and mortality. However, only the STOP-Hypertension Trial has shown a reduction in total mortality with active treatment. Patients under 80 years with an SBP > or = 160 mmHg and DBP > or = 90 mmHg or SBP > or = 160 mmHg and DBP < 90 mmHg should be considered for anti-hypertensive therapy, initially using non-pharmacological methods. Thiazide diuretics and beta-blockers remain first-line pharmacological therapy, the long-term benefits of other types of anti-hypertensive agent have yet to be assessed. In general the negative attitudes to treating hypertension in the elderly can no longer be upheld, although in certain sub-groups the benefits of treatment are as yet unproven.