Statement on Hypertension in the Elderly

Research indicates that isolated systolic hypertension, as well as diastolic hypertension, is associated with increased morbidity and mortality in people over age 65. According to data from the 1976 to 1980 National Health and Nutrition Examination Survey, the prevalence of these combined types of hypertension (≥140 /90 mm Hg) is estimated to be 64% in persons aged 65 to 74 years, with an even higher prevalence in blacks (76%) than in whites (63%). Although a number of studies have demonstrated the benefits of antihypertensive therapy in elderly patients, many questions unique to this population remain unanswered. This article addresses several of these issues and presents recommended guidelines on topics such as the pressure at which treatment should be initiated, goal pressure for people over age 65, antihypertensive drugs of choice and appropriate dosages, the accuracy of indirect measurements, side effects specific to elderly patients, and the effect of treatment on the quality of life. (JAMA1986;256:70-74)