Hypertension in the Elderly: Conventional Wisdom Revisited

Elevated systolic and/or diastolic blood pressure in the elderly is a problem the extent of which may be somewhat overstated. In those elderly with definite hypertension, pathophysiology may differ from that of younger counterparts. The contribution of elevated plasma renin activity to hypertension and to the choice of therapy also appears to be exaggerated. The risks of ignoring hypertension in the elderly are similar to those in younger patients, and therefore excessively elevated blood pressure should no longer be considered a normal consequence of aging. Notably, elevated systolic pressure is a better predictor of future adverse occurrences than is elevated diastolic pressure. Unfortunately, there is no well defined therapeutic regimen to manage isolated systolic hypertension. Conservative reduction of elevated systolic and diastolic pressures may nevertheless be accomplished safely and effectively. Individualization of therapy is recommended based primarily on concomitant disease(s). Thus no single agent or combination of agents is preferable in all elderly hypertensive patients. Aggressive use of non-pharmacologic therapy preferably precedes judicious of antihypertensive medication. Aggressive blood pressure reduction with potent drugs is not recommended.