Hypertension in the Older Patient: Practical Clinical Management

Hypertension is an important risk factor for cardiovascular morbidity and mortality in the elderly. Isolated systolic hypertension is particularly prevalent, because of structural and functional changes of the arteries and alterations in salt sensitivity and neural function with aging. Blood pressure lowering therapy has been shown to reduce the morbidity and mortality in the elderly. There is little doubt that a healthy lifestyle including diet, physical activity and ideal body weight is the foundation of hypertension management. Adequate lifestyle changes may reduce the need for antihypertensive drugs, but most older people with elevated BP will require a combination of antihypertensive drugs for ideal blood pressure control. An achieved systolic blood pressure of less than 150 mmHg seems to be effective and safe to date, while stricter goals may be appropriate, if tolerated. Careful attention should be required to postural and postprandial hypotension. Optimal blood pressure goal for the elderly remains inconclusive and needs to be further investigated.