Hypertension in elderly persons.
OBJECTIVE
To provide an overview of the prevalence of hypertension in the elderly population and discuss the advantages and disadvantages of various classes of antihypertensive drugs.


METHODS
We review the published clinical trials on treatment of elderly patients with hypertension and describe adverse reactions that are frequently associated with antihypertensive therapy.


RESULTS
On the basis of the standard for control of hypertension established by the National Health and Nutrition Examination Survey for 1988-1991 (140/90 mm Hg), almost 75% of all African-Americans and 50% of all whites 60 to 74 years of age have hypertension. If modifications in lifestyle (such as weight reduction and increase in exercise) do not normalize blood pressure levels, drug therapy is warranted. Meta-analyses of major trials of treatment of hypertension have revealed significant reductions in cardiovascular-related mortality and stroke, and available data indicate that prudent use of antihypertensive agents is associated with an acceptable degree of toxicity. Low-dose thiazide diuretics and b-blockers remain the agents of choice.


CONCLUSIONS
Several trials have substantiated the effectiveness of treatment of hypertension in elderly subjects. Drug therapy should be initiated at low doses, and careful follow-up should monitor for adverse effects.
Hamilton
B P
BP
Department of Medicine, Baltimore VA Medical Center, Baltimore, Maryland 21201, USA.
Hamilton
J H
JH