Hypertension control in the elderly.

Hypertension is highly prevalent in older persons and most often presents as isolated systolic hypertension. Systolic blood pressure (BP) is a stronger predictor of risk than diastolic BP in persons older than 50 years. Most of these patients will require multiple drug therapies to achieve the substantial reductions in systolic BP needed to reach target levels. Clinical trials have demonstrated that antihypertensive therapy with beta-blockers and diuretics as well as with calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type 1 receptor blockers reduces cardiovascular risk in older patients. Studies examining safety and BP-lowering efficacy have shown that a renin-angiotensin-aldosterone system blocker plus a calcium channel blocker as well as a combination of diuretics and beta-blockers or diuretics plus an angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor blocker achieves greater BP reductions than monotherapy. Such multiple drug regimens are well tolerated in older patients.