The management of cardiovascular disease in the elderly.

Elevated blood pressure (either isolated systolic levels above 1150-160 mm Hg, or diastolic/systolic elevations), left ventricular hypertrophy, and possibly decreased high-density lipoproteins (HDL) and increased low-density lipoprotein (LDL) are significant risk factors for cardiovascular disease in the elderly. Treatment of other precursors, such as total cholesterol or triglycerides, is probably not warranted in this group. For the management of hypertension, administration of diuretics with the judicious use of adrenergic inhibitors and vasodilators is indicated. In treating patients who have congestive heart failure, dosages of agents such as digoxin must be carefully adjusted. Antiarrhythmics are generally not well tolerated by the elderly. Whenever possible, polypharmacy should be avoided to prevent adverse interactions.