Hypertension in the elderly: the time has come to treat.

Both pure systolic, and systolic plus diastolic hypertension are risk factors for cerebrovascular and cardiovascular disease in patients over 65 years old, but the efficacy of antihypertensive therapy in preventing the complications of hypertension in the elderly has been questioned. The risks associated with such therapy seem to have been overemphasized. Although the evidence is incomplete, elderly patients should be treated when the systolic blood pressure exceeds 160 mm Hg or the diastolic pressure exceeds 95 mm Hg, or both. A revised stepped-care approach, with use of vasodilating agents as the Step-2 drugs, is proposed.