High blood pressure in older persons: a high risk special population.

Blood pressure (BP), particularly systolic blood pressure (SBP), rises with advancing age. Isolated systolic hypertension is the most common type of hypertension (HTN) phenotype after age 70. Moreover, at similar BP levels the absolute risk for CVD is several fold higher in elderly than in young patients. End-organ damage is common, and significant renal impairment can be present even when serum creatinine levels are normal. All forms of HTN in the elderly should be treated. A recent meta-analysis of eight clinical trials involving elderly patients documented a 15/6 mm Hg treatment difference between intervention and control groups, and a lower rate of stroke, CHD and death from all causes in the intervention group. Gradual BP control into the "normal" range should be the goal in elderly patients. There is no convincing evidence that lowering BP is harmful (J-curve hypothesis). Coexisting medical conditions influence therapeutic choices. The suggested medical evaluation of elderly hypertensive patients with suspected secondary forms of HTN is covered as well as pervasive clinical myths about HTN in the elderly.