Hypertension: how does management change with aging?

Hypertension is a significant risk factor for cardiovascular morbidity and mortality in people older than 60 years. Isolated systolic hypertension and widened pulse pressure appear to be more important than diastolic hypertension. Very low blood pressure and orthostatic hypotension are associated with increased mortality, and should be checked for at every visit. Best evidence suggests that adjusting hypertension goals with age, and starting therapy when blood pressure is greater than 160/90 leads to improved outcomes. Therapy should start with a thiazide diuretic (best evidence) or an angiotensin-converting enzyme inhibitor.