Antihypertensive drug therapy in older patients.

Elevated pulse pressure is an important cardiovascular risk factor in the elderly, and it remains to be determined whether this can be reversed. Drug treatment is justified in older patients with isolated systolic hypertension whose systolic blood pressure is 160 mmHg or higher on repeated measurement. Absolute benefit is greater in men, in patients aged 70 years or more, and in those with previous cardiovascular complications or greater pulse pressure. In the recently published comparative trials blood pressure gradients largely accounted for most, if not all, of the differences in outcome. In hypertensive patients, calcium-channel blockers may offer greater protection against stroke than against myocardial infarction, resulting in an overall cardiovascular benefit similar to that provided by older drug classes. The hypothesis that angiotensin-converting enzyme inhibitors or alpha-blockers might influence outcome over and beyond that expected on the basis of their blood pressure lowering effects still remains to be proved.