Hypertension in women and the elderly. Some puzzling and some expected findings of treatment studies.

Almost 65% of the US population over age 60 has hypertension (systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg), which is strongly related to increased rates of coronary artery disease (CAD), stroke, and death. The need for treatment seems obvious. However, in young and middle-aged women, treatment is not straightforward, and trials have not specifically targeted this group. Data extrapolated from existing studies suggest that treatment of hypertension does not confer the same protection against CAD and stroke in women as it does in men. In fact, a trend toward harm in young and middle-aged white women receiving stepped care for hypertension has been reported. Therefore, for now, treatment of women in this age-group should be conservative; drugs should be prescribed only after a focused trial of lifestyle modification has failed. Until recently, elderly subjects were also excluded from treatment studies, despite the fact that they are at high risk for morbidity and death from hypertension-related diseases. Recent studies have established that treatment of hypertension in the elderly is extremely effective, that elderly women should be treated as aggressively as elderly men, and that low-dose diuretic or beta-blocker therapy should be initiated if lifestyle modifications are not effective.