National high blood pressure education program working group report on hypertension in the elderly

Abstract

Raised blood pressures in the elderly and the increased prevalence of hypertension in this population are not benign occurrences and should not be viewed as a normal or inevitable consequence of aging. In fact, the relation of systolic and diastolic blood pressures to cardiovascular events is generally more pronounced in people aged 65 years and older when compared with those aged 35 to 64. The relative risk of cardiovascular disease is greater among the elderly at every level of blood pressure. Furthermore, the absolute likelihood that an older individual will have a cardiovascular event is substantially greater than for someone younger, reflecting the increased prevalence of other cardiovascular disease risk factors in this age group. Thus, equivalent blood pressure reduction is likely to produce a greater benefit in the elderly than in younger patients at every level of blood pressure. This report, an update of the 1985 Working Group Report on Hypertension in the Elderly, has two aims: to guide clinicians in their care of elderly patients with hypertension and to assist health care professionals participating in high blood pressure control programs that serve the elderly. The role of lifestyle modifications - weight loss, dietary sodium restriction, alcohol reduction, and exercise - as definitive or adjunctive therapy to drug treatment is discussed. In addition, the report reviews the relative advantages and disadvantages of the specific classes of antihypertensive medications.