Hypertension in very old subjects.

The role of hypertension as a risk factor for mortality and cardiovascular morbidity and the benefits of antihypertensive treatment are well established in older patients up to 80 years. For people aged 85 and over, who are the most rapidly growing segment of population in developed countries, data are scarce and conflicting. A positive association between blood pressure and survival has been found in several cohort studies, and this relation held true after adjustment for many factors. In randomized trials, the benefits of antihypertensive treatment declined with age and were not observable after 80 years, with the exception of the SHEP study. People who reach a very old age share some characteristics which make them different from the bulk of "60 (or 65) and over" and justify special studies which are currently in progress. In the meantime, any treatment decision can only rely on extrapolations moderated by common sense.