This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (38)  • Contact me when this article is cited  Related Content  • Related letters  • Similar articles in JAMA  Topic Collections  • Aging/ Geriatrics  • Hypertension  • Alert me on articles by topic  Social Bookmarking   What's this?

Sarwat I. Chaudhry, MD; Harlan M. Krumholz, MD, SM; JoAnne Micale Foody, MD

JAMA. 2004;292:1074-1080.

Context  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure emphasizes the importance of systolic hypertension (SH), defined as systolic blood pressure (SBP) of at least 140 mm Hg and diastolic blood pressure of less than 90 mm Hg, in older persons (60 years).

Objective  To systematically review the literature on clinical management of SH in older persons.

Data Sources  We performed a MEDLINE search of English-language literature from 1966-2004 to identify reports about SH in older persons, with particular emphasis on data from randomized clinical trials.

Study Selection and Data Extraction  We selected 1064 studies by using the search terms hypertension combined with the terms systole (or systolic) and aged.

Data Synthesis  There is strong evidence from clinical trials to support the treatment of SH in older persons with SBP of at least 160 mm Hg. Large-scale trials to assess the value of antihypertensive therapy for older patients with SBP of 140 to 159 mm Hg have not been performed, and recommendations to treat these patients are based on observational studies that show a graded relationship of cardiovascular risk with increasing SBP. The studies most strongly support the use of thiazide diuretics and long-acting calcium channel blockers as first-line therapy to treat SH.

Conclusions  Treatment of SH in older patients with SBP of at least 160 mm Hg is supported by strong evidence. The evidence available to support treatment of patients to the level of 140 mm Hg or those with baseline SBP of 140 to 159 mm Hg is less strong; thus, these treatment decisions should be more sensitive to patient preferences and tolerance of therapy.

Author Affiliations: Department of Veterans Affairs, West Haven Veterans Affairs Medical Center, West Haven, Conn (Dr Chaudhry); Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine (Drs Krumholz and Foody), Center for Outcomes Research and Evaluation, Yale New Haven Hospital (Dr Krumholz), Department of Epidemiology and Public Health, Section of Health Policy and Administration (Dr Krumholz), and The Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine (Dr Krumholz), New Haven, Conn.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Systolic Hypertension in Elderly Persons

JAMA. ;292():2465-2465.
FULL TEXT  

Systolic Hypertension in Elderly Persons

JAMA. ;292():2465-2466.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Outcomes Research: Generating Evidence for Best Practice and Policies
Krumholz
Circulation 2008;118:309-318.
FULL TEXT  

Older Patients Need Better Guidelines for Optimal Treatment of High Blood Pressure: 1 Size Fits Few
Krakoff
Hypertension 2008;51:817-818.
FULL TEXT  

Recording blood pressure readings in elderly patients' charts: What patient and physician characteristics make it more likely?
Broomfield et al.
cfp 2008;54:230-231.
ABSTRACT | FULL TEXT  

Is it Time for a Cardiovascular Primary Prevention Trial in the Elderly?
Robinson et al.
Stroke 2007;38:441-450.
ABSTRACT | FULL TEXT  

Blood pressure and ageing
Pinto
Postgrad. Med. J. 2007;83:109-114.
ABSTRACT | FULL TEXT  

Hypertension and the Treating Physician: Understanding and Reducing Therapeutic Inertia
Fine and Cutler
Hypertension 2006;47:319-320.
FULL TEXT  

Hypertension in Adults Across Age Groups
Cheng
JAMA 2005;294:2971-2971.
FULL TEXT  

Epidemiology of Uncontrolled Hypertension in the United States
Wang and Vasan
Circulation 2005;112:1651-1662.
FULL TEXT  

Hypertension in Adults Across the Age Spectrum: Current Outcomes and Control in the Community
Lloyd-Jones et al.
JAMA 2005;294:466-472.
ABSTRACT | FULL TEXT  

Control of Hypertension in Adults With Chronic Kidney Disease in the United States
Peralta et al.
Hypertension 2005;45:1119-1124.
ABSTRACT | FULL TEXT  

Systolic Hypertension in Elderly Persons
Baker
JAMA 2004;292:2465-2465.
FULL TEXT  

Systolic Hypertension in Elderly Persons
Sharma
JAMA 2004;292:2465-2466.
FULL TEXT