Hypertension in the elderly.

Publication of the SHEP study (Systolic Hypertension in the Elderly Programme) leaves no doubt that isolated systolic hypertension in the elderly should be treated. There are, however, a number of important outstanding questions: (a) the mechanism of reduction of morbidity, (b) because antihypertensive therapy appears to be more effective in elderly patients than in the young, when should treatment be started in relation to progression of age?, (c) besides the blood pressure elevation, what are the exact mechanical factors responsible for degeneration of the arterial wall?, and (d) what in 1993 is the definition of hypertension? These are questions that now need to be answered.