Practical recommendations for treatment of hypertension in older patients

Abstract

By the year 2030 the percent of the population over the age of 65 years is projected to range from 3.7% (in sub-Saharan Africa) to almost 22% (in Europe). Accompanying this unprecedented growth will be a significant increase in many of the disease processes or "comorbidities" associated with aging, not the least of which is hypertension. Global health care resources and economies in general will be stressed to breaking point if this condition is not dealt with in an aggressive and timely manner because the consequences of untreated hypertension such as stroke, myocardial infarction, and dementia are exceedingly costly in the long term. To help focus attention on the worldwide epidemic of hypertension, the current literature and guidelines were reviewed, along with information on the various classes of medications indicated in the treatment of hypertension in the elderly. Recent, large, randomized trials indicate that hypertension in the elderly can and should be treated to lower the incidence of stroke, myocardial infarction, and chronic kidney disease. Although thiazide-type diuretics are the recommended first-line agents in most cases of uncomplicated hypertension, multiple drug classes have been shown to be useful. In addition, and where feasible, a multidisciplinary team approach has demonstrated the most durable results. Thiazide diuretics should be the first-line agents in uncomplicated, isolated systolic hypertension. Starting at low doses and proceeding in a gradual manner, these agents have proven efficacy in decreasing the risk of stroke and cardiovascular events. It is now recommended that these agents be used in low-dose combinations with other antihypertensive drug classes in patients who do not achieve target blood pressure (<140/90 mmHg).