Therapy in the elderly hypertensive

The number of people over the age of 65 years continues to increase. In most societies blood pressure (BP) increases with age and elevated levels of BP are common in the elderly. The elderly are also a high-risk group for cardiovascular (CV) disease, which is the leading cause of death in most developed countries. Several intervention trials have confirmed lower CV disease risk in hypertensive patients aged into their early eighties when treated with a variety of antihypertensive drugs. Whilst there is some limited evidence to suggest that β-blockers may not be as effective as thiazide diuretics in reducing coronary heart disease (CHD) or total mortality in the elderly, the combination of the two agents and thiazides alone appear to be as effective as newer agents, such as angiotensin-converting enzyme inhibitors (ACE-I) and calcium antagonists. There was no evidence from these trials that BP reduction in the elderly was associated with any deleterious effects. Whilst the benefits of treating the elderly hypertensive are well established, some issues remain to be clarified, particularly in relation to treating the very elderly and the potential benefits beyond BP control that may be afforded by newer antihypertensive agents.