Hypertension in the elderly: a review of the importance of systolic blood pressure elevation.

Abstract

The elderly, those 65 years of age and older, will account for 20% of the population by the year 2040. Hypertension affects more than one half of the elderly and its prevalence continues to increase with age. The presence of hypertension confers an increased risk of stroke, congestive heart failure, coronary heart disease, end-stage renal disease, and death. Although both diastolic and systolic blood pressure elevations are independently associated with increased cardiovascular risk in the younger individual, as vascular compliance becomes reduced at age 60, an increasing systolic blood pressure and lower diastolic blood pressure (or wider pulse pressure) increase cardiovascular risk in the elderly. Isolated systolic hypertension is the most common form of hypertension seen in the elderly. Lifestyle modification, including weight loss and salt restriction, reduces blood pressure, and may decrease the need for pharmacologic therapy. When the systolic blood pressure is 160 mm Hg or more and the diastolic blood pressure is <90 mm Hg, the initial use of a diuretic-based or calcium channel blocker-based regimen improves outcome. Alpha blocker therapy should not be used as initial monotherapy. Most elderly hypertensives will require two to three drugs to achieve the present blood pressure goal of <140 mm Hg. Caution should be exercised when lowering diastolic pressure to <55 mm Hg in those with isolated systolic hypertension. Although side effects of therapy are no more likely to occur in the elderly than in the younger individual with hypertension, blood pressure reduction should be accomplished gradually.