Outcomes of treating hypertension in the elderly: a short commentary on current issues.
Because treating hypertension in the elderly so effectively reduces major cardiovascular events, it is vital to diagnose this very common condition early. Much of the hypertension that occurs with aging results from stiffening of the major capacitance arteries, typically marked by high systolic and low diastolic blood pressures. Pulse pressure, derived by subtracting diastolic from systolic values, is a useful index of stiffness, but new noninvasive techniques for measurement of arterial compliance have shown that blood pressures cannot reliably predict the state of the arteries in older people. The Systolic Hypertension in the Elderly Program (SHEP) and the Systolic Hypertension in Europe (Syst-Eur) trial demonstrated that treating hypertension in the elderly with diuretics or calcium channel blockers reduces strokes and cardiac events; these results are also clearly evident in high-risk groups like diabetics. Further analysis of Syst-Eur has suggested that a calcium channel blocker reduces new-onset dementia, while follow-up data from SHEP indicate that a diuretic provides survival and stroke benefits in obese or overweight elderly hypertensives, but not in the lean. In general, comparisons of antihypertensive agents, including diuretics, beta blockers, angiotensin-converting enzyme inhibitors, and calcium channel blockers have found similar clinical end point effects. But recently, the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study, performed in patients (average age, 67) with left ventricular hypertrophy and predominant systolic hypertension, showed that the angiotensin receptor blocker losartan was significantly more effective than the beta blocker atenolol in reducing such key outcomes as strokes and new-onset diabetes. Even so, careful but effective control of blood pressure in elderly patients, including those over age 80, still remains a critical factor in preventing major cardiovascular events.
Weber
Michael A
MA
Office of Scientific Affairs, SUNY Downstate College of Medicine, Brooklyn, NY 11203, USA. michaelwebermd@cs.com
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001158:Arteries / Q000473:pathology; D015992:Body Mass Index; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D003071:Cognition / Q000187:drug effects; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000503:physiopathology; D004232:Diuretics / Q000627:therapeutic use; D004548:Elasticity; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D019808:Losartan / Q000627:therapeutic use; D020913:Perindopril / Q000627:therapeutic use; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D019808:Losartan; D020913:Perindopril