Tailoring anti-hypertensive treatment in the elderly

The treatment of hypertension in the elderly has to take into account co-existing pathology. However, the benefit from treatment are large in terms owing to the frequency of cardiovascular events in the elderly. The benefits observed in randomised controlled trials are reviewed together with the adverse effects of the individual treatments. The optimal use of anti-hypertensive treatment is considered in light of any concomitant disease; for example beta-blockers or calcium channel blockers when angina is present and the avoidance of diuretics in the presence of gout. Important hazardous drug interactions are also discussed. It is concluded that diuretics are still the first choice in uncomplicated hypertension and the least expensive. However the place of anti-hypertensive treatment is not established in those over the age of 80 years.