Office Management of Hypertension in Older Persons

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. (C) 2011 Elsevier Inc. All rights reserved. The American Journal of Medicine (2011) 124, 498-500