Treatment of hypertension in the elderly patient, particularly isolated systolic hypertension
- Brent M Egan, MD
Brent M Egan, MD
- Professor of Medicine
- University of South Carolina School of Medicine-Greenville
- Chief Science Officer, Care Coordination Institute
- Section Editors
- George L Bakris, MD
George L Bakris, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Professor of Medicine
- The University of Chicago
- Norman M Kaplan, MD
Norman M Kaplan, MD
- Editor-in-Chief — Nephrology
- Section Editor — Hypertension
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical Center
- Kenneth E Schmader, MD
Kenneth E Schmader, MD
- Editor in Chief — Geriatric Medicine
- Section Editor — Geriatrics
- Chief, Division of Geriatrics
- Duke University
- Director, Geriatric Research Education and Clinical Center
- Durham VA Medical Centers
- Deputy Editors
- John P Forman, MD, MSc
John P Forman, MD, MSc
- Senior Deputy Editor — UpToDate
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
- Daniel J Sullivan, MD, MPH
Daniel J Sullivan, MD, MPH
- Deputy Editor — Primary Care (Adult)
- Assistant Professor of Medicine
- Harvard Medical School
Hypertension is a common problem in elderly persons (age greater than 60 to 65 years), reaching a prevalence as high as 60 to 80 percent (figure 1A-B) [1-4]. In the United States, for example, hypertension was observed in 67 percent of adults aged 60 years and older who were participants in the National Health and Nutrition Examination Survey (NHANES) .
A related issue is the risk of developing hypertension over time in an elderly person who is normotensive. This issue was addressed in two reports from the Framingham Heart Study:
●One study examined the incidence of hypertension (defined as blood pressure greater than 140/90 mmHg or use of antihypertensive drug) over a four-year period among individuals who initially had optimal (less than 120/80 mmHg), normal (120 to 129/80 to 84 mmHg), or high-normal (130 to 139/85 to 89 mmHg) blood pressure . There was a progressive increase in the frequency of development of hypertension in patients over age 65 years (16, 26, and 50 percent in the optimal, normal, and high-normal groups, respectively). Similar findings were noted in younger individuals, but the rates of progression were lower.
●The second report estimated that individuals aged 55 to 65 years who do not have hypertension have a 90 percent lifetime risk of developing stage 1 hypertension (blood pressure 140 to 159/90 to 99 mmHg) and a 40 percent lifetime risk of developing stage 2 hypertension (blood pressure ≥160/≥100 mmHg) .
HYPERTENSION AWARENESS AND CONTROL
A report from the National Health and Nutrition Examination Survey (NHANES) evaluated the trends in hypertension prevalence, awareness, treatment, and control in the United States from 1988 to 2008 . The overall results from this analysis are discussed elsewhere. (See "The prevalence and control of hypertension in adults" and "Patient adherence and the treatment of hypertension", section on 'Introduction'.)
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- HYPERTENSION AWARENESS AND CONTROL
- ISOLATED SYSTOLIC HYPERTENSION
- Importance of diastolic pressure
- EVIDENCE FOR EFFICACY OF BLOOD PRESSURE LOWERING
- Lifestyle modifications
- Antihypertensive therapy
- - Meta-analysis
- - SHEP trial
- - Syst-Eur trial
- - MRC trial
- - HYVET trial
- More versus less intensive blood pressure lowering
- DRUG THERAPY
- General principles
- - Problem of orthostatic hypotension
- - Problem of frailty
- Choice of antihypertensive drugs
- - ALLHAT trial
- - Long-acting calcium channel blockers
- - Angiotensin inhibition
- - Beta blockers
- - ACCOMPLISH trial of combination therapy
- - Summary of antihypertensive drug choice
- Uncontrolled hypertension
- Resistant hypertension
- GOAL BLOOD PRESSURE
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS