Hypertension in Elderly Patients

PURPOSE: To synthesize and analyze new information on the epidemiology, pathophysiology, and management of hypertension in the elderly to guide physicians making treatment decisions. DATA IDENTIFICATION: An English-language literature search using MEDLINE (1972-1988) and bibliographic reviews of textbooks and review articles. STUDY SELECTION: Primary research articles on the epidemiology, pathophysiology, and management of hypertension in the elderly were reviewed. Particular emphasis was placed on large randomized clinical trials. DATA EXTRACTION: Study design and quality were assessed, with particular attention to subject selection, sample size, definition of outcome variables, and applicability of the results to management of the elderly hypertensive patient. RESULTS OF DATA SYNTHESIS: Epidemiologic studies confirm that elevated systolic blood pressure in the elderly is more highly correlated with subsequent cardiovascular morbidity and mortality than is elevation of diastolic blood pressure. Results of several large randomized trials of the treatment of diastolic hypertension in elderly patients indicate that treatment is beneficial, at least up to age 80. For instance, the European Working Party on Hypertension in the Elderly reported that drug treatment resulted in a significant relative reduction (27%) in overall cardiovascular mortality, or an absolute reduction of 29 fewer cardiovascular events per 1000 person-years of treatment. Data from well-designed studies are not available to make a definitive statement about the treatment of isolated systolic hypertension. CONCLUSION: The cardiovascular risk reduction from treating mild to moderate diastolic hypertension in the elderly is significant, but the magnitude of absolute risk reduction is not so great that treatment should invariably be pursued if serious side effects cannot be avoided.