Controlling hypertension in the elderly

Open Access
Publisher Website
Google Scholar
Abstract
Hypertension is best defined as the level of blood pressure above which treatment does more good than harm. This information comes from the results of randomized controlled trials, i.e. the evidence base. However, we do not know the level of blood pressure at which treatment fails to confer an overall benefit. Such a level is predicted to exist, as at lower levels of blood pressure, few gain by having cardiovascular events prevented yet all are at risk of the adverse effects of treatment. At the beginning of 2000, we know that at most ages it is worth treating a systolic blood pressure ≥160 mmHg and/or a diastolic blood pressure ≥90 mmHg. This has not prevented speculation that treatment should be started at say, a systolic pressure of 140–159 mmHg. 1, 2 Nevertheless caution must be expressed that adverse effects may outweigh advantages in certain groups, for example the very elderly (>80 years) and those whose blood pressure is high when lying but low on standing. The same may apply to those with a high blood pressure when first seen but normal pressures thereafter; although transient hypertension, at least in men, still confers an excess cardiovascular risk. 3 Obviously we should consider the over‐80s further, assess blood pressure in the standing position, and determine the sustained level of blood pressure.

This publication has 0 references indexed in Scilit: