Hypertension in the elderly.

Both systolic and diastolic blood pressure increase with advanced age and more than 50% of hypertensive patients are aged above 65 years. Age-related vascular and neuro-humoral changes are important factors leading to the development of hypertension in the elderly and the increase in systolic and diastolic blood pressure with age in any individual is a consequence of the relative change in arterial resistance and stiffness. Therefore, hypertension is predominantly or purely systolic in the elderly both in women and men. The risks of hypertensive patients over the age of 65 years are significant and several trials have provided compelling evidence that treatment of hypertension in the elderly is beneficial in terms of reduced morbidity and mortality. Goal blood pressure should be similar in older and younger patients. Lifestyle modifications are of proven benefit and may be the only therapy needed for stage 1 hypertension. The Sixth report of the JNC recommends diuretics, specifically thiazide diuretics as the initial choice for the treatment of elderly patients without any comorbid conditions. Beta-blockers are less effective than thiazides as first line treatment and may only reduce stroke events. Recently, dihydropiridine calcium antagonists have been advocated as first choice agents for the treatment of hypertension in the elderly and are suitable alternatives when diuretics are ineffective, contraindicated or not tolerated. Newer drugs such as AT1 antagonists are also effective in lowering blood pressure in the elderly but large scale data concerning their protective effects are still lacking.