Treatment of hypertension in the elderly
H. I. Tjoa and N. M. Kaplan
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-8852.
Hypertension, both combined diastolic plus systolic and isolated systolic,
is common in the elderly. Elderly hypertensive patients pose a number of
diagnostic dilemmas, including pseudohypertension, postural and
postprandial decreases in blood pressure, and the potential for
renovascular hypertension. Data from large clinical trials have documented
protection from cardiovascular complications by antihypertensive therapy
for elderly people with combined systolic and diastolic hypertension.
However, no data are available concerning the value of therapy for those
with isolated systolic hypertension. Until such data become available from
the Systolic Hypertension in the Elderly Program in 1991, cautious
reduction of elevated systolic blood pressure levels is recommended. The
fragile physiologic characteristics of the elderly demand caution and
gentleness in the use of any therapy to lower blood pressure. Nondrug
therapies are safe and may be effective. A variety of drugs are available
and can be used to gradually reduce blood pressure to presumably safer
levels.
