Treatment of the elderly hypertensive patient.
It is generally accepted that increased blood pressure, especially high systolic blood pressure, is a major risk indicator in people over 60 years of age. Retrospective analyses of published trials show that when the elevation in arterial pressure has been firmly established by repeated blood pressure measurements, antihypertensive treatment should be considered for the following subgroups. (1) All elderly hypertensive patients with grade III or IV retinopathy, congestive heart failure or cerebral infarction or hemorrhage should be treated regardless of age or degree of blood pressure elevation. (2) In elderly patients with established mild hypertension and no symptoms or complications, non-pharmacological treatment should be started in patients less than 80 years of age, with antihypertensive drugs prescribed if diastolic pressure reaches 100 mmHg or more over 3 months or 95 mmHg or more over 6 months of follow-up. The therapeutic benefit of pharmacologic antihypertensive treatment has not yet been established in hypertensive patients over 80 years of age or in those with isolated systolic hypertension. All things considered, the indication to intervene pharmacologically should be viewed as becoming gradually more compelling as blood pressure rises. The more closely a patient's characteristics match those of a subset of elderly hypertensive patients in whom therapeutic benefit has been proven, the greater the need for pharmacologic treatment.
Amery
A
A
Department of Pathophysiology, K.U. Leuven, Belgium.
Fagard
R
R
Lijnen
P
P
Staessen
J
J
Van Hoof
R
R
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001581:Benzothiadiazines; D004232:Diuretics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000401:mortality; D015201:Meta-Analysis as Topic; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use
D000959:Antihypertensive Agents; D001581:Benzothiadiazines; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors