Therapeutic needs of the elderly patient.

Since 1967, results from well-controlled long-term studies have provided convincing evidence for the benefit of antihypertensive therapy in middle-aged patients. However, many physicians have hesitated to apply these findings to patients over 60 years of age. Recently, the results of several prospective, randomized long-term trials of antihypertensive drug treatment in elderly hypertensive patients have been published. An analysis of the results of six major trials shows that antihypertensive treatment reduces overall mortality by 20%, cardiovascular mortality by 34%, the incidence of fatal and nonfatal cerebrovascular events by 40%, and the complications of coronary heart disease (i.e., fatal and nonfatal myocardial infarction and sudden cardiac death) by 16%. In absolute terms, antihypertensive therapy is much more beneficial in elderly patients than in middle-aged patients with mild hypertension. These results are related to both combined systolic and diastolic and to isolated systolic hypertension. There is therefore a clear indication for antihypertensive drug treatment of elderly hypertensive patients. Selection of the type of antihypertensive therapy in elderly hypertensive patients must consider the high frequency of isolated systolic hypertension, the multimorbidity, and the need for multiple drug prescription. In these circumstances, the fixed combination of an angiotensin-converting enzyme inhibitor and a calcium antagonist offers several advantages, associated with a high response rate and good tolerability.