The Importance of Systolic Blood Pressure Control and Cardiovascular Disease Prevention.

Hypertension affects up to 75% of individuals 60 years of age and older. Cardiovascular risk is related to increases in systolic blood pressure and pulse pressure and to decreases in diastolic blood pressure, but systolic blood pressure reduction is the major target for improving outcomes in the elderly patient. Hypertension therapy in older individuals should include lifestyle modification, especially weight loss and sodium restriction, which may decrease the need for antihypertensive medication. The starting dose of medication should be one half that used in younger patients. If low initial doses are used, significant attention must be paid to adequate titration; combination therapy is usually required for optimal blood pressure control. The initial agent chosen is rarely the final agent used to achieve the recommended minimal systolic blood pressure goal of less than 140 mm Hg. If more than one agent is required, a diuretic should be included as one of the agents chosen. Although the reduction of blood pressure should occur more gradually in the older patient, the treatment goals should be similar and determined by the underlying concomitant disorder. The minimum goal should remain less than 140/90 mm Hg, with lower goals in diabetic patients and those with renal disease. Patients with isolated systolic hypertension should have a minimum systolic blood pressure goal of less than 140 mm Hg.