Hypertension in the elderly: benefits of treatment.

It has long been known that hypertension increases the risk of cardiovascular morbidity and mortality and that this risk increases with age. It has taken much longer to establish that lowering the blood pressure in elderly subjects will reduce this risk. Early studies published in 1985-86 indicated that treating classical essential hypertension in elderly subjects who were mainly less than 75 years of age, or even below 70 years, did reduce cardiovascular morbidity and mortality. More recent studies have extended the evidence and established that major benefits can be harvested by treating mild and moderate hypertension in subjects between 70 and 85 years who have classical hypertension with raised diastolic and systolic blood pressure. Recent evidence has also established that the treatment of isolated systolic hypertension in elderly patients up to the age of 80 and above, will reduce morbidity and mortality. In all of these recent studies, the major gain of lowering the pressure has been a reduction in the incidence of fatal and non-fatal stroke, but there is also some evidence of reduction in risk associated with coronary artery disease. Overall the evidence of benefit is sufficiently strong to advise the practising doctor to lower the blood pressure in elderly patients up to the age of 85 with raised diastolic or systolic blood pressure.