Hypertension in the elderly.

Hypertension is the most important risk factor for cardiovascular events in the elderly, and it is present in more than 50% of the American population over 60 years of age. Both systolic and diastolic blood pressure are directly related to increasing cardiovascular risk and systolic pressure becomes even more important in the elderly. Borderline isolated systolic hypertension confers an 80% likelihood of developing definite hypertension over 20 years, as well as a higher risk for cardiovascular events. The morbidity trials in the elderly, especially the Systolic Hypertension in the Elderly Program, have clearly demonstrated the benefits of treating hypertension in the elderly in all subgroups examined. Although these benefits have been seen with diuretic (and to a lesser extent beta-blocker) regimens, physicians initiated therapy less often with these drugs during 1990 and 1991. All of the major classes of drugs are effective in lowering blood pressure in older whites, and calcium antagonists and diuretics are most effective in older black patients.