Antihypertensive Therapy In Elderly Patients Research Articles

Features of the treatment of arterial hypertension in elderly patients

Arterial hypertension (AH) is one of the most common problems in the elderly and one of the most important cardiovascular risk factors. AH in the elderly has features with a high incidence of ISAH and is characterized by a high level of SBP and a low level of DBP, which creates certain problems for the safety of treatment. The need for antihypertensive therapy in elderly patients has received convincing evidence of the effectiveness of reducing mortality and cardiovascular complications. The purpose of this scientific review was to raise awareness of the problem of treating hypertension in elderly patients, including those with low DBP. The results of studies and meta-analyzes evaluating the efficacy and safety of standard and intensive SBP reduction in elderly patients, as well as the results of the effect of antihypertensive therapy on DBP levels, especially at baseline low DBP (<70 mmHg), are presented. The studies identified the main groups of antihypertensive drugs that provide an effective and safe reduction in blood pressure in elderly patients, have a cardioprotective effect and do not adversely affect comorbidities. These include: diuretics of the thiazide-like group, calcium channel blockers, as well as additional indications and concomitant conditions – ACE inhibitors and antigotensin II receptor blockers. Several meta-analyses have shown the benefit of intensively lowering SBP < 120 mmHg before the standard target level SBP < 140 mmHg. in elderly patients as a lower risk of fatal and non-fatal cardiovascular events and overall mortality. Thus, the impact of intensive SBP reduction was beneficial in preventing 1 case of MACE (NNT = 38) and in preventing 1 case of total mortality (NNT = 85); while the rate of harm in the form of arterial hypotension was significantly high (NNH = 778). With regard to the effect on the level of DBP in elderly patients with hypertension or ISAH, an inverse relationship between DBP and adverse coronary events was revealed and a J-curve was described, confirmed in a number of studies (INVEST, ARIC, SPRINT). Moreover, with an initially low DBP (<70 mmHg), a significant increase in the frequency of outcomes and the relative risk of outcomes was noted. It is not easy to decide on antihypertensive therapy in such situations. The evidence base of studies suggests the benefit of lowering SBP for the prevention of cardiovascular events in elderly patients, but with caution and individual approach. It is important to take into account individual patient characteristics such as cognition, autonomy, and frailty/frailty when setting target BP.

Selection of antihypertensive therapy in elderly patients, combination therapy: thiazide-like diuretics and calcium channel blockers

The article presents data about the prevalence and expected prognosis for arterial hypertension. Emphasis is placed on the selection of antihypertensive therapy in elderly patients. The features concerning the positive effect of the calcium channelblocking agent — amlodipine, thiazid­like diuretic — indapamide retard in the form of monotherapy and a combination of the above drugs on the course and prognosis of arterial hypertension in elderly patients are investigated. A clinical example of the use of the fixed dose combination amlodipine + indapamide retard is also introduced.

Arterial Hypertension in Older Adults in the Light of New European Guidelines 2018

The tendency of aging of the population and, together with it, the increase in the prevalence of arterial hypertension (HT) determines the need to study the peculiarities of treatment of HT in patients of elderly and senile age. In this regard, in the new Guidelines of the European Society of Cardiology for diagnosis and treatment of HT (2018), the authors identified groups of elderly patients (aged 65-79 years) and very elderly patients (aged ≥80 years), blood pressure (BP) levels for the initiation of antihypertensive therapy and target BP levels, and recommended the main principles of antihypertensive therapy. The new recommendations of the ESH/ESC in 2018 also presented the characteristics of HT management in elderly patients. The necessity of mandatory detection of senile asthenia in elderly patients and determination of the degree of their independence from outside help is emphasized. In all elderly patients, especially in very elderly or fragile patients, it is recommended to evaluate the presence or development of orthostatic hypotension during treatment, as well as actively to detect episodes of hypotension using the 24-hour BP monitoring. For antihypertensive therapy in elderly patients, the same five classes of antihypertensive drugs and their combination are recommended. It is emphasized that if it is not required for the treatment of concomitant diseases, loop diuretics and alpha-blockers should be avoided because their use is associated with an increased risk of falls. It is recommended to investigate the level of serum creatinine more often to evaluate the kidney function and to detect a possible decrease in the glomerular filtration rate because of a decrease in BP and perfusion of the kidneys. The target BP levels indicated in the Guidelines are: systolic BP values 130-139 mm Hg and diastolic BP 70-80 mm Hg. In the Guidelines it is emphasized that elderly patients need careful monitoring of any adverse side effects of antihypertensive drugs.

THE EFFICACY OF ANTIHYPERTENSIVE THERAPY IN ELDERLY PATIENTS AND TREATMENT COMPLIANCE ANALYSIS

Aim. To study the efficacy of antihypertensive therapy in elderly patients under the condition of research program and outpatient practice by ambulatory blood pressure (BP) monitoring (ABPM) and office BP evaluation, as well as explore patients' treatment compliance. Material and methods. Patients with arterial hypertension, 1-2 degree (n=75) were included into the study. Patients were invited to in-person physician visit again after 4 years. Evaluation of office BP, ABPM, Morisky-Green questionnaire survey was performed. Besides patients were asked to give their understanding of factors that could influence treatment compliance. Patients were divided into 2 cohorts (adherers and non-adherers), depending on the results of Morisky-Green questionnaire survey. Results. Contact was got in 50 of 75 patients after 4 years. Only 10 of patients (20%) were compliant according to Morisky-Green questionnaire survey, and 13 patients (26%) revealed a high risk of non-compliance. 26 of patients (52%) forgot to take medications, 25 patients (50%) were inaccurate regarding time of drug administration. Some patients missed medicines taking when they were in good condition (58%), or they were unwell (36%) due to sharp BP decrease after taking drugs. Conclusion. The patients' treatment compliance remains one of the most important problems of chronic diseases therapy. Only 20% of elderly hypertensive patients are compliant.

COMPARISON OF THE EFFECTS OF FOUR ANTIHYPERTENSIVE THERAPY VARIANTS ON ARTERIAL WALL ELASTICITY IN ELDERLY PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION

Aim.To compare the effects of various antihypertensive therapy (AHT) variants on the ultrasound-assessed elasticity of common carotid arteries (CCA) and thoracic aorta in elderly patients with nonvalvular atrial fibrillation (AF).Material and methods.In total, 364 patients (208 men and 156 women) with nonvalvular AF, aged 65–80 years, were randomised into four groups. Group I (n=91) received perindopril (5–10 mg/d); Group II (n=92) and Group III (n=90) were administered valsartan only (80–160 mg/d) or valsartan (80–160 mg/d) plus rosuvastatin (10 mg/d), respectively; and Group IV (n=91) received lercanidipine (10–20 mg/d). Vascular ultrasound methods were used to assess the thoracic aorta and CCA elasticity and ankle-brachial index.Results.The two-year therapy with perindopril, valsartan, valsartan plus rosuvastatin, and lercanidipine was associated with the increased CCA distensibility index, reduced aortic wall stiffness, and decreased pulse wave velocity, compared to the respective baseline levels. Out of four AHT variants, the combination of valsartan (80–160 mg/d) and rosuvastatin (10 mg/d) demonstrated the largest effect on the arterial wall elasticity and the greatest reduction in the risk of ischemic stroke, myocardial infarction, and death.Conclusion.While choosing AHT in elderly patients with nonvalvular AF, the combination of valsartan and rosuvastatin could be regarded as the optimal therapeutic regimen, which improves arterial wall elasticity and reduces the risk of cardiovascular complications.

Pharmacoeconomic issues of antihypertensive therapy in elderly patients (older than 75 years)

Objective. To carry out a pharmacoeconomic analysis of the antihypertensive therapy in elderly patients of high cardiovascular risk by the means of the method assessing «expenses - benefits», cost minimization, the increment of cost efficiency. Results. The cost of the daily efficient dose of the original (Renitec, MSD) and generic Enalapril (Hemofarm) was 6,54 and 7,25 rubles, respectively. Minimal coefficient «expenses - benefits» was defined in the group of patients receiving two drug combination therapy including original Enalapril (Renitec, MSD) compared to combination of three drugs including generic Enalapril (Hemofarm) while the antihypertensive effect was comparable. The cost efficiency increment (CER incr) was 169,12 rubles regarding original Enalapril (Renitec, MSD) benefit.

Present and Prospective Clinical Therapeutic Options for the Elderly Patient with Hypertension

Purpose The purpose of this review was to summarize current treatment guidelines and recently published studies about the efficacy and safety of antihypertensive therapy in elderly patients. Methods A literature research (MEDLINE) was performed with respect to the prevalence of hypertension in the elderly, the underlying pathophysiological mechanisms and current treatment options. Results Hypertension affects up to 70% of the population aged 65 years and older and results in a significant increase of cardiovascular morbidity and mortality. Antihypertensive drug therapy reduces the risk of cardiovascular complication and end organ damage not only in younger, but also in elderly patients. The most frequently applied classes of antihypertensive medication are diuretics, beta-blockers, ACE-inhibitors, angiotensin II-AT1-receptor blockers, calcium channel blockers, alpha-adrenergic receptor antagonists, centrally acting drugs and vasodilators. Side effects of antihypertensive medication have to be considered especially in the vulnerable elderly patients. The recently published HYVET study added important information on the value of antihypertensive therapy in patients at an age of 80 years or older. In the treatment group with indapamide and periondopril (compared to the placebo group) the risk of stroke was reduced by 30%, all-cause mortality by 21% and cardiovascular mortality by 23%. Conclusion Co-morbidities and age related changes of pharmacokinetics and pharmacodynamics require a very distinct choice of therapy in elderly people. Individual drug classes might be of advantage in certain conditions, including diabetes mellitus, renal dysfunction, heart failure and stroke.

Comparison of Monotherapy Versus Combination Antihypertensive Therapy in Elderly Patients With Essential Hypertension

Authors sought to compare the efficacy of monotherapy versus combination antihypertensive therapy in elderly patients. Patients in this study, aged 65 to 85 years, were divided into 4 groups and entered an 8-week treatment period. First group: 22 patients, amlodipine 5 mg/d increasing to 10 mg; second: 20 patients, eprosartan 600 mg/d increasing to 600 mg twice a day; third: 21 patients, amlodipine 5 mg/d and indapamide 2.5 mg/d, increasing amlodipine to 10 mg/d; fourth: 23 patients, imidapril 10 mg/d and indapamide 2.5 mg/d, imidapril doubled to 20 mg/d. A greater drop in systolic and in diastolic blood pressure was obtained by combination of amlodipine and indapamide compared with amlodipine or eprosartan monotherapy. Imidapril and indapamide showed similar efficacy compared with eprosartan monotherapy but not with amlodipine monotherapy. Amlodipine and indapamide appeared more effective than imidapril and indapamide in diastolic blood pressure. Combination treatment with amlodipine and indapamide or imidapril and indapamide effectively reduces blood pressure in elderly patients with essential hypertension.

Spotlight on the Pharmacoeconomics of Candesartan Cilexetil in Chronic Heart Failure and Hypertension1

The addition of candesartan cilexetil (Atacand®, Amias®, Biopress®, Kenzen®, Ratacand®) to standard therapy for chronic heart failure (CHF) provided important clinical benefits at little or no additional cost in France, Germany, and the UK, according to a detailed economic analysis focusing on major cardiovascular events and prospectively collected resource-use data from the CHARM-Added and CHARM-Alternative trials in patients with CHF and left ventricular (LV) systolic dysfunction. Results of a corresponding cost-effectiveness analysis showed that candesartan cilexetil was either dominant over placebo or was associated with small incremental costs per life-year gained, depending on the country and whether individual trial or pooled data were used. Preliminary data from a US cost-effectiveness analysis based on CHARM data also showed favorable results for candesartan cilexetil. Two cost-effectiveness analyses of candesartan cilexetil in hypertension have been published, both conducted in Sweden. Data from the SCOPE trial in elderly patients with hypertension, which showed a significant reduction in nonfatal stroke with candesartan cilexetil-based therapy versus non-candesartan cilexetil-based treatment, were incorporated into a Markov model and an incremental cost-effectiveness ratio of €12 824 per quality-adjusted life-year (QALY) gained was calculated (2001 value). Another modelled cost-effectiveness analysis of candesartan cilexetil was based on the ALPINE trial, in which the incidence of new-onset diabetes was significantly lower in patients with newly diagnosed hypertension who were randomized to candesartan cilexetil (with or without felodipine) than among those who received hydrochlorothiazide (with or without atenolol). Although candesartan cilexetil was dominant over hydrochlorothiazide, the ALPINE cost-effectiveness analysis relied on a small number of clinical events and did not evaluate the incremental cost of candesartan cilexetil per life-year or QALY gained. In conclusion, despite some inherent limitations, economic analyses incorporating CHARM data and conducted primarily in Europe have shown that candesartan cilexetil appears to be cost effective when added to standard CHF treatment in patients with CHF and compromized LV systolic function. The use of candesartan cilexetil as part of antihypertensive therapy in elderly patients with elevated blood pressure was also deemed to be cost effective in a Swedish analysis, primarily resulting from a reduced risk of nonfatal stroke (as shown in the SCOPE study); however, the generalizability of results to other contexts has not been established. Cost-effectiveness analyses comparing candesartan cilexetil with ACE inhibitors or other angiotensin receptor blockers in CHF or hypertension are lacking, and results reported for candesartan cilexetil in a Swedish economic analysis of ALPINE data focusing on outcomes for diabetes require confirmation and extension.

Candesartan Cilexetil

The addition of candesartan cilexetil (Atacand, Amias, Blopress, Kenzen, Ratacand) to standard therapy for chronic heart failure (CHF) provided important clinical benefits at little or no additional cost in France, Germany and the UK, according to a detailed economic analysis focusing on major cardiovascular events and prospectively collected resource-use data from the CHARM-Added and CHARM-Alternative trials in patients with CHF and left ventricular (LV) systolic dysfunction. Results of a corresponding cost-effectiveness analysis showed that candesartan cilexetil was either dominant over placebo or was associated with small incremental costs per life-year gained, depending on the country and whether individual trial or pooled data were used. Preliminary data from a US cost-effectiveness analysis based on CHARM data also showed favourable results for candesartan cilexetil. Two cost-effectiveness analyses of candesartan cilexetil in hypertension have been published, both conducted in Sweden. Data from the SCOPE trial in elderly patients with hypertension, which showed a significant reduction in nonfatal stroke with candesartan cilexetil-based therapy versus non-candesartan cilexetil-based treatment, were incorporated into a Markov model and an incremental cost-effectiveness ratio of euro12 824 per QALY gained was calculated (2001 value). Another modelled cost-effectiveness analysis of candesartan cilexetil was based on the ALPINE trial, in which the incidence of new-onset diabetes was significantly lower in patients with newly diagnosed hypertension who were randomised to candesartan cilexetil (with or without felodipine) than among those who received hydrochlorothiazide (with or without atenolol). Although candesartan cilexetil was dominant over hydrochlorothiazide, the ALPINE cost-effectiveness analysis relied on a small number of clinical events and did not evaluate the incremental cost of candesartan cilexetil per life-year or QALY gained. In conclusion, despite some inherent limitations, economic analyses incorporating CHARM data and conducted primarily in Europe have shown that candesartan cilexetil appears to be cost effective when added to standard CHF treatment in patients with CHF and compromised LV systolic function. The use of candesartan cilexetil as part of antihypertensive therapy in elderly patients with elevated blood pressure was also deemed to be cost effective in a Swedish analysis, primarily resulting from a reduced risk of nonfatal stroke (as shown in the SCOPE study); however, the generalisability of results to other contexts has not been established. Cost-effectiveness analyses comparing candesartan cilexetil with ACE inhibitors or other angiotensin receptor blockers in CHF or hypertension are lacking, and results reported for candesartan cilexetil in a Swedish economic analysis of ALPINE data focusing on outcomes for diabetes require confirmation and extension.

The Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive Patients (JATOS): Protocol, Patient Characteristics, and Blood Pressure during the First 12 Months

The benefits of a systolic blood pressure (BP) below 150-160 mmHg are well established; whether a systolic BP of less than 140 mmHg provides additional benefits remains controversial. This study was designed to compare the 2-year effect of a strict treatment to maintain systolic BP below 140 mmHg (group A) and that of a mild treatment to maintain systolic BP at between 140 and below 160 mmHg (group B). The study design followed the Prospective Randomized Open Blinded End-point (PROBE) study. The subjects were elderly patients (65-85 years old) who consistently had a systolic BP of 160 mmHg or higher. The baseline drug was efonidipine hydrochloride (efonidipine), a long-acting dihydropiridine calcium antagonist. The primary endpoints were stroke, cardiac disease, vascular disease, and renal failure. After a run-in period of 2 to 4 weeks, 2,165 patients were assigned to group A and 2,155 patients to group B. There were no significant differences between the groups in sex, age, baseline BP, or other cardiovascular risk factors. The systolic BP was 7.2 mmHg lower (p < 0.0001) and the diastolic BP 2.4 mmHg lower (p < 0.0001) in group A than in group B after 12 months of treatment. As of this interim analysis, primary endpoints have occurred in 87 patients (stroke in 58 patients, cardiac disease in 27 patients, occlusive arterial disease in 1 patient, and renal failure in 1 patient). Five patients have died of stroke and 2 patients of myocardial infarction. The primary-endpoint-related morbidity rate was 20.9/1,000 patient-years, and the mortality rate was 1.7/1,000 patient-years. Currently available results indicate that this study, one of the largest randomized trials of antihypertensive therapy in elderly patients in Japan, was conducted safely. The final results are expected to provide important and practical information for the management of hypertension in elderly patients.

Effect of baseline cognitive function on outcomes in the study on cognition and prognosis in the elderly (scope)

P-417 Key Words: Cognitive Function, Elderly Hypertensives, Angiotensin Receptor Blocker

Health-related quality of life during treatment of elderly patients with hypertension: results from the Study on COgnition and Prognosis in the Elderly (SCOPE)

The Study on COgnition and Prognosis in the Elderly (SCOPE) was a multinational, randomised, double-blind study to assess the effects of candesartan 8-16 mg daily on cardiovascular events and cognitive function in elderly patients (aged 70-89 years) with mild to moderate hypertension. A total of 4937 patients were randomised to candesartan or placebo with other antihypertensive drugs (mostly diuretics, beta-blockers, and calcium antagonists) added as needed to control blood pressure. Only 16% of the patients in the control group received placebo alone. The mean follow-up was 3.7 years. The aim of this health-related quality of life (HRQL) substudy analysis was to investigate changes in HRQL during antihypertensive treatment, and possible differences in patients receiving candesartan-based or other antihypertensive treatment. Three validated HRQL instruments were used: the Psychological General Well-being (PGWB) Index, the Subjective Symptoms Assessment Profile (SSA-P), and the EuroQoL Health Utility Index (EuroQoL). The HRQL was generally good at baseline and well preserved during follow-up in the presence of substantial blood pressure reductions in both treatment groups. Several of the observed changes in score from baseline to last visit favoured candesartan-based compared to control treatment, particularly the changes in PGWB Anxiety (-0.5 vs -1.0, P=0.01), PGWB Positive well-being (-0.8 vs -1.1, P=0.04), SSA-P Cardiac symptoms (0.03 vs 0.10, P=0.03), and EuroQoL Current health (-3.1 vs -5.3, P=0.008). This favourable result may be related to the somewhat lower blood pressure associated with candesartan-based treatment. In conclusion, there should be no reason to withhold modern antihypertensive therapy in elderly patients due to concerns for a negative effect on HRQL.

Interactions of l-arginine, isosorbide mononitrate, and angiotensin II inhibitors on arterial pulse wave

Background Deficiency of nitric oxide (NO) production has been implicated in the pathogenesis of increased pulse wave reflection associated with systolic hypertension. We investigated the effects on systolic blood pressure (BP) and pulse wave contour of two nitrate donors, isosorbide mononitrate (ISMN) and l-arginine. Methods The subjects were 14 elderly patients chronically treated with antihypertensive agents. In seven of the subjects, agents causing angiotensin II (AII) inhibition (angiotensin-converting enzyme [ACE] inhibitor or AT 1 receptor antagonist, or both) were used. Study entry required systolic BP of 150 to 200 mm Hg, and aortic pulse wave augmentation more than 15 mm Hg. Pharmacodynamic responses to ISMN, l-arginine, and ISMN plus l-arginine, were assessed in double-blind crossover studies by standard sphygmomanometry and applanation tonometry. Results Peripheral systolic BP, aortic systolic BP, and the aortic augmentation index were decreased ( P < .001) by ISMN, irrespective of AII inhibition. l-Arginine enhanced these effects ( P < .001) in the subjects without AII inhibition, but not in those receiving AII inhibitors. Given without ISMN or AII inhibitors, l-arginine decreased peripheral systolic BP, but to a lesser extent than ISMN. Conclusions l-Arginine has potential value as an adjunct to ISMN in combination with antihypertensive therapy in elderly patients with systolic hypertension. However, when given with single-dose ISMN, its vasodilator activity may overlap with that of AII inhibitors. Future studies of l-arginine in conjunction with chronic continuous ISMN dosing are warranted.

Changes in the circadian blood pressure pattern due to antihypertensive therapy in elderly patients

Changes in the circadian blood pressure pattern due to antihypertensive therapy in elderly patients

Target Blood Pressure in Elderly Hypertensive Patients: How Low Should You Go?

Epidemiological studies have highlighted the increasing prevalence of hypertension with age, and the associated increase in the risk of cardiovascular disease. A number of randomized controlled trials have shown that antihypertensive treatment significantly reduces cardiovascular mortality and morbidity in elderly patients, and there is evidence that the benefit achieved is related to the extent to which blood pressure is lowered. Furthermore, a recent analysis of data from the Hypertension Optimal Treatment (HOT) Study shows that intensive therapy produces significantly greater reductions in blood pressure in elderly patients than in younger patients, without increasing the risk of adverse events. As a result, the latest management guidelines recommend that the goal of antihypertensive therapy in elderly patients should be to achieve at least high normal blood pressures (below 140/90 mmHg). Angiotensin II type 1 receptor antagonists offer a new option for antihypertensive therapy in elderly patients, and trials such as the Study on Cognition and Prognosis in the Elderly (SCOPE) are currently investigating the effect of these agents on cardiovascular mortality and morbidity in elderly hypertensive patients.

Reducing Cardiovascular Morbidity and Mortality in the Elderly

Candesartan cilexetil is highly effective at lowering blood pressure, whilst maintaining placebo-like tolerability, in a wide range of patient groups. Although the benefit of lowering blood pressure in elderly patients with moderate hypertension has been demonstrated in several large-scale clinical trials, elderly patients with mild hypertension have rarely been studied. The high incidence of cardiovascular and cerebrovascular mortality and morbidity, including dementia, in the elderly means that control of blood pressure is particularly important in this patient group. A major new international clinical trial - SCOPE (Study on COgnition and Prognosis in the Elderly) - has therefore been initiated. This is a prospective, randomized, double-blind, parallel comparison of the effects of candesartan cilexetil, 8 or 16 mg once daily, and placebo in about 5000 patients who will be followed for a mean of 2.5 years. SCOPE is the first study designed to assess the effect of antihypertensive therapy in elderly patients (70-89 years of age) with mild hypertension (sitting systolic blood pressure of 160-179 mmHg and/or sitting diastolic blood pressure of 90-99 mmHg). The primary objective of the study is to determine the effect of candesartan cilexetil on major cardiovascular events (cardiovascular death, non-fatal stroke and myocardial infarction, and silent myocardial infarction), while an important secondary objective is to determine the effect of such treatment on the prevention of cognitive impairment. SCOPE should provide definitive evidence of the cardiovascular and cerebrovascular benefits of treating mildly hypertensive elderly patients with angiotensin II type 1 receptor blockers, which not only reduce blood pressure, but may also provide significant protection from the negative effects of angiotensin II on target organs.

A pragmatic study of the withdrawal of antihypertensive therapy in elderly patients: a 1-year follow-up

A pragmatic study of the withdrawal of antihypertensive therapy in elderly patients: a 1-year follow-up

Systolic hypertension in the elderly. Relationship with cardiovascular disease.

The risk of stroke and myocardial infarction is increased in patients with elevated systolic blood pressure. Although treatment trials have demonstrated the benefit of antihypertensive therapy in elderly patients with diastolic hypertension, the only trial conducted in elderly patients with isolated systolic hypertension is currently in progress. A six-month trial of nonpharmacologic therapy should generally be the initial treatment in patients with isolated systolic hypertension. Then, if systolic pressure remains elevated, a cautious trial of drug treatment is reasonable. The drug used should be started in a low dose, and the dose should be titrated slowly. With this approach, antihypertensive treatment of elderly patients with isolated systolic hypertension may be well tolerated and ultimately beneficial.

Statement on hypertension in the elderly. The Working Group on Hypertension in the Elderly

Research indicates that isolated systolic hypertension, as well as diastolic hypertension, is associated with increased morbidity and mortality in people over age 65. According to data from the 1976 to 1980 National Health and Nutrition Examination Survey, the prevalence of these combined types of hypertension (greater than or equal to 140/90 mm Hg) is estimated to be 64% in persons aged 65 to 74 years, with an even higher prevalence in blacks (76%) than in whites (63%). Although a number of studies have demonstrated the benefits of antihypertensive therapy in elderly patients, many questions unique to this population remain unanswered. This article addresses several of these issues and presents recommended guidelines on topics such as the pressure at which treatment should be initiated, goal pressure for people over age 65, antihypertensive drugs of choice and appropriate dosages, the accuracy of indirect measurements, side effects specific to elderly patients, and the effect of treatment on the quality of life.