title: Office management of hypertension in older persons.
abstract: Antihypertensive drug therapy reduces cardiovascular events in older persons. In the Hypertension in the Very Elderly Trial, at 1.8-year follow-up, patients aged 80 years and older treated with antihypertensive drug therapy had a 30% reduction in fatal or nonfatal stroke (P=.06), a 39% reduction in fatal stroke (P=.05), a 21% reduction in all-cause mortality (P=.02), a 23% reduction in death from cardiovascular causes (P=.06), and a 64% reduction in heart failure (P<.001). The goal of treatment of hypertension is to lower the blood pressure to less than 140/90 mm Hg in older persons and to less than 130/80 mm Hg in older persons with diabetes or chronic kidney disease if tolerated. The selection of antihypertensive drug therapy in persons with associated medical conditions depends on their medical conditions. Large meta-analyses of published trials show that thiazide diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, angiotensin receptor antagonists, and beta-blockers do not significantly differ in their ability to lower blood pressure and to exert cardiovascular protection in older and younger persons. If the blood pressure is more than 20/10 mm Hg above the goal blood pressure, drug therapy should be initiated with 2 antihypertensive drugs. Other coronary risk factors must be treated.
authors: Department of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Valhalla, USA. wsaronow@aol.com
authors: Wilbert S
authors: WS
authors: Aronow