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  • Title: Hypertension in the elderly.
    Author: LaPalio LR.
    Journal: Am Fam Physician; 1995 Sep 15; 52(4):1161-5. PubMed ID: 7668206.
    Abstract:
    A systolic blood pressure greater than 160 mm Hg is a more significant risk factor for cardiovascular disease than a diastolic blood pressure greater than 95 mm Hg, regardless of a patient's age. Treatment of isolated systolic hypertension significantly reduces the incidence of both fatal and nonfatal cardiovascular events, even in patients who are over 80 years of age. Non-pharmacologic measures and behavior modification should be tried for three to six months in a patient with mildly elevated blood pressure (140 to 160 mm Hg/90 to 100 mm Hg). If these measures fail or the patient has target-organ disease or multiple cardiac risk factors, medication may be prescribed earlier. Half the usual recommended dose should be initially prescribed in the frail elderly. Long-acting diuretics or beta blockers are recommended first-line agents. Angiotensin-converting enzyme inhibitors, calcium channel blockers and alpha blockers have not been shown to reduce mortality in hypertensive patients who do not have comorbid disease. Angiotensin-converting enzyme inhibitors may benefit hypertensive patients with heart failure, and calcium channel blockers may help those with angina, especially vasospastic angina.
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