The case for treating hypertension in the elderly.

Not so long ago it was fashionable to ignore a little bit of hypertension in an elderly person. The rationalizations for this position included the limited epidemiological data establishing the risk of elevated blood pressure in the age group over 65, particularly for women; and concern that lowering the blood pressure might not be desirable, from the standpoint of reduced blood flow to vital organs. There was also concern over the known greater responsiveness or sensitivity of older people to customary doses. It was also argued by some that even if the blood pressure could be safely controlled it was hardly worth it, since age itself is the most powerful predictor of mortality in the elderly. Moreover, it seemed unlikely to many that the risk of hypertension could be reduced--that is, that life expectancy could be extended; at the same time it seemed fairly certain that the quality of life would be compromised by therapy. However, since systolic blood pressure continues to be predictive of coronary heart disease mortality well into the ninth decade, and since considerable life expectancy remains for those who have survived to their senior years, it seems logical to attempt to reduce the risk and preserve life expectancy by controlling blood pressure. The question is, is the evidence that treatment helps really convincing, or are we simply extrapolating from studies carried out in younger subjects? Review of the early literature, which focused almost exclusively on stroke survivors and the influence of hypertension on stroke recurrence, provides inconsistent, conflicting, and not persuasive information.(ABSTRACT TRUNCATED AT 250 WORDS)