The elderly hypertensive population: what lies ahead of us?

In the next 25 years, the population aged 65 years and over will increase by 88%. Thus, postponing the adverse effects of old age for as long as possible will be a major social and economic issue. Hypertension is common in older people, with a prevalence rate of up to 60%, the majority having isolated systolic hypertension. Both isolated systolic hypertension and increased pulse pressure (PP) are associated with a high cardiovascular (CV) risk, and hypertension remains the biggest treatable risk factor for CV disease in the elderly and in the very old. Randomised, controlled trials have demonstrated the benefit of the treatment of hypertension in this population, such that treating just 43 subjects (95% CI: 31–69) for five years would prevent one cerebro-vascular event and treating 61 (95% CI: 39–141) would prevent one coronary event. It should be stressed that antihypertensive treatment reduces both fatal and nonfatal events and will probably prevent the onset of dementia. In other words, it reduces events that represent a major source of disability and handicap in old age and allows healthy ageing. Ongoing trials, which are addressing the preventive effect of treatment in the very elderly hypertensive, will provide further evidence as to the risk/benefit ratio in this ever increasing age group.