The hypertensive patient

Treatment of both systolic-diastolic and isolated systolic hypertension in patients over age 65 has been shown to decrease subsequent cardiovascular morbidity and mortality. In the European Working Party on High Blood Pressure in the Elderly study, the number of morbid and mortal cardiovascular events prevented in the treatment group was 29/1,000 person-years, whereas in the Systolic Hypertension in the Elderly Program, the number was 55/1,000 person-years. This magnitude of reduction is substantial, but in the case of primary prevention in the elderly, a large number of patients must be treated to benefit relatively few. Better strategies of targeting treatment based on risk over and above that of high blood pressure are needed. Certainly, patients with more than one cardiovascular risk factor or evidence of end-organ damage should be treated more aggressively.