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Treatment of hypertension in the elderly patient, particularly isolated systolic hypertension

Author
Brent M Egan, MD
Section Editors
George L Bakris, MD
Norman M Kaplan, MD
Kenneth E Schmader, MD
Deputy Editor
John P Forman, MD, MSc

EPIDEMIOLOGY

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) [3].

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 [5]. 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) [6].

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 [4]. The overall results from this analysis are discussed elsewhere. (See "The prevalence and control of hypertension" and "Patient adherence and the treatment of hypertension", section on 'Introduction'.)

                           

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Literature review current through: Nov 2016. | This topic last updated: Tue Jun 28 00:00:00 GMT+00:00 2016.
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