Hypertension in elderly patients.
OBJECTIVE
To synthesize and analyze new information on the epidemiology, pathophysiology, and management of hypertension in the elderly to guide physicians making treatment decisions.


METHODS
An English-language literature search using MEDLINE (1972-1988) and bibliographic reviews of textbooks and review articles.


METHODS
Primary research articles on the epidemiology, pathophysiology, and management of hypertension in the elderly were reviewed. Particular emphasis was placed on large randomized clinical trials.


METHODS
Study design and quality were assessed, with particular attention to subject selection, sample size, definition of outcome variables, and applicability of the results to management of the elderly hypertensive patient.


RESULTS
Epidemiologic studies confirm that elevated systolic blood pressure in the elderly is more highly correlated with subsequent cardiovascular morbidity and mortality than is elevation of diastolic blood pressure. Results of several large randomized trials of the treatment of diastolic hypertension in elderly patients indicate that treatment is beneficial, at least up to age 80. For instance, the European Working Party on Hypertension in the Elderly reported that drug treatment resulted in a significant relative reduction (27%) in overall cardiovascular mortality, or an absolute reduction of 29 fewer cardiovascular events per 1000 person-years of treatment. Data from well-designed studies are not available to make a definitive statement about the treatment of isolated systolic hypertension.


CONCLUSIONS
The cardiovascular risk reduction from treating mild to moderate diastolic hypertension in the elderly is significant, but the magnitude of absolute risk reduction is not so great that treatment should invariably be pursued if serious side effects cannot be avoided.
Applegate
W B
WB
University of Tennessee, Memphis.
D000368:Aged; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000145:classification / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors
D000959:Antihypertensive Agents