Elderly hypertensives and quality of life: some methodological considerations.

Management of mild hypertension in the elderly aims at symptom relief and a change in the natural history of hypertension. This is often difficult, since mild hypertension is generally symptomless but drug therapy may have serious quality of life sequelae. Therefore, aspects of patient well-being, including physical, emotional, and social status, should become important treatment considerations, which can be achieved by a patient-specific approach. Quality of life claims for specific drugs appeal to the desire of the prescriber to use the best drug in real-life situations. Physicians generally are guided in their selection of a particular drug for a particular patient by results of clinical trials. This is still difficult to achieve with quality of life studies pertaining to drug management of mild hypertension in the elderly. Few studies have been done, and some do not yield clear results. One needs to study carefully the duration of the trial, the validation of the instruments used, the approach to confounding factors such as inclusion and stratification of elderly by decade of life, inclusion of females in requisite numbers and prior symptoms of patients who, more likely than not, suffer from a host of intercurrent diseases and have been placed on multiple drugs.