Abstract

Hypertension (defined as blood pressure over 140/90 mm Hg) affects more than two out of three individuals over 75 years of age. Treatment with blood pressure lowering medications reduces the risk for strokes and heart failure by 35%. Monotherapy is clearly inadequate for controlling BP and for preventing outcomes of cardiovascular disease and stroke in the elderly. Combinations of antihypertensive drugs are required by most hypertensives. Thiazide-type diuretics are recognized as the cornerstone of antihypertensive therapy. Ca-channel blocking agents have performed particularly well in preventing stroke in elderly hypertensives. ACE-inhibitors and angiotensin II blockers have been demonstrated to be most useful in combination therapy with a diuretic or  CCB. When treating the elderly for hypertension, it is also necessary to consider other medical conditions that they may have. Antihypertensive therapy is recommended to be started at low doses and increased slowly to avoid a too rapid or excessive lowering of blood pressure. It is important to measure blood pressure in the elderly while they are standing in addition to while they are sitting or lying. Last but not least, it is suggested not to lower diastolic pressure below 55-60 mm Hg to avoid increase of side effects by reducing the circulation of blood to the tissues of the body. All this information indicates demonstrates that hypertension in the elderly is a significant problem that deserves more attention.