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Hypertension in the elderly.

As many as forty percent of Canadians over age sixty-five have blood pressure readings of 160/90 or higher. They are at greater risk for stroke, congestive heart failure, myocardial infarction and sudden death. Hypertension appears to be an exaggeration of the normal circulatory changes of aging--increased systemic vascular resistance and a slight decrease in cardiac output at rest and during exercise. The major trials of treatment for hypertension have included subsets of elderly hypertensives who have enjoyed about the same overall benefit from treatment as younger subjects. Two treatment trials specifically for elderly hypertensives also show that treating systolic-diastolic hypertension does more good than harm. Isolated systolic hypertension appears to be a risk factor of equal magnitude to systolic/diastolic hypertension. Although it is possible to treat isolated systolic hypertension, the definitive clinical trial comparing mortality and morbidity in treated and untreated groups is not yet published. Thiazides, while inexpensive and effective antihypertensives for the elderly, are relatively contraindicated in as many as half. Other classes of drugs, particularly calcium channel blockers, can be effective alternatives. Many, if not most, elderly hypertensives will be prescribed more than one type of antihypertensive in addition to other types of drugs. The possibility of drug interactions as well as the danger of overly rapid blood pressure reduction must be kept in mind.