Hypertension in the elderly

Hypertension (HT) is a common problem in elderly persons (age >65 years), reaching a prevalence as high as 60 to 80%. Isolated systolic HT mostly occurs in older patients. Treatment of HT in all patients, independent of age, consists of lifestyle modifications and antihypertensive therapy. Randomized trials have provided clear evidence of benefit from treating HT in elderly patients, including those over the age of 80 years. Drug therapy should be started in elderly hypertensive patients if lifestyle changes are insufficient and in the absence of a hypertensive emergency or urgency, blood pressure reduction should always be gradual. A long-acting dihydropyridine or a thiazide diuretic is generally preferred because of increased blood pressure-lowering efficacy in this population. Goal blood pressure recommendation for most hypertensive elderly is to attain a systolic pressure below 140 mmHg.