Hypertension in the elderly.

Hypertensive patients over the age of 60 years clearly are at risk from cardiovascular disease whether their hypertension is systolic or diastolic or both. The higher the blood pressure is and the greater the age, the greater is the morbidity. New studies indicate that elderly patients with diastolic blood pressure greater than or equal to 90 mm Hg benefit from drug therapy. The few studies of drug treatment in patients with systolic hypertension do not indicate that such therapy is clearly beneficial, although diuretic therapy seems to prevent the occurrence of congestive heart failure. Well-controlled trials of treatment are necessary to indicate the place of antihypertensive drugs in this population. The frequent presence of other disease, changes in liver and kidney function, and unusual responses to drugs are problems that make drug therapy relatively unpredictable in elderly hypertensive patients. Because these patients may respond with blood pressure reduction to weight loss or to a reduction in dietary salt, these measures should be used when feasible in their care.