Geriatric hypertension: chairman's comments on the NIH Working Group report.

Of the more than 25,000,000 people in the United States older than 65 years, more than 60% have hypertension. Approximately 10% of the elderly people have isolated systolic hypertension (systolic blood pressure greater than or equal to 160 mm Hg, diastolic less than 90 mm Hg). Hypertension in the elderly, either systolic or diastolic, increases the risk of cardiovascular morbidity and mortality as much as it does for younger patients. Three large, controlled clinical trials have shown that diuretic-based stepped care therapy will reduce the risk of cardiovascular mortality for patients 60 years of age and older who have diastolic hypertension. In general, elderly patients tolerate antihypertensive drugs as well as younger patients do, and they are as compliant as younger patients. As yet, there is no evidence from controlled trials that drug treatment reduces the risk for patients with isolated systolic hypertension.