Treatment of hypertension in older adults, 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
- 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
- William B White, MD
William B White, MD
- Section Editor — Hypertension
- Professor of Medicine
- Chief, Hypertension and Clinical Pharmacology
- Calhoun Cardiology Center
- University of Connecticut School of Medicine, Farmington
- Past President
- American Society of Hypertension 2012-2014
- Blood Pressure Monitoring
- 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 older adults (age greater than 60 to 65 years), reaching a prevalence as high as 70 to more than 80 percent [1,2]. In the United States, for example, hypertension, defined as systolic blood pressure ≥130 mmHg and/or diastolic blood pressure ≥80 mmHg was observed in 76 percent of adults aged 65 to 74 years and 82 percent of adults aged 75 years or older who were participants in the National Health and Nutrition Examination Survey (NHANES) .
Hypertension control rates are lower among older patients. In the same study mentioned above, control of blood pressure to <130/<80 mmHg among those taking antihypertensive drug therapy was achieved by 54, 50, 46, and 33 percent of individuals aged 20 to 54 years, 55 to 64 years, 65 to 74 years, and 75 or more years, respectively .
A related issue is the risk of developing hypertension over time in an older adult who is normotensive. This issue was addressed in two reports from the Framingham Heart Study that defined hypertension as a systolic pressure ≥140 and/or a diastolic pressure ≥80 mmHg:
●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 mild hypertension (blood pressure 140 to 159/90 to 99 mmHg) and a 40 percent lifetime risk of developing more severe hypertension (blood pressure ≥160/≥100 mmHg) .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- 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