Wilbert S. Aronow, MD, CMD, Clinical Professor of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care Medicine; Chief, Cardiology Clinic; Senior Associate Program Director and Research Mentor, Fellowship Programs, Department of Medicine, New York Medical College, Valhalla, NY; Adjunct Professor of Geriatrics and Adult Development, Mount Sinai School of Medicine, New York City, NY, USA.
Older patients are more likely to have hypertension and isolated systolic hypertension, to have target organ damage and clinical cardiovascular disease, and to develop myocardial infarction, angina pectoris, stroke, congestive heart failure, and peripheral arterial disease. Yet, considering the increased risk of cardiovascular death, older patients are less likely to have hypertension controlled. Antihypertensive drug therapy reduces coronary events, stroke, heart failure, and cardiovascular death in older patients. The goal of treatment of hypertension in older patients is to reduce the blood pressure to less than 140/90mmHg and to ≤130/80mmHg in older patients with diabetes mellitus or chronic renal insufficiency. Diuretics should be used as initial drug therapy in older patients with hypertension and no associated medical conditions. The selection of antihypertensive drug therapy in older patients depends on the associated medical conditions.
Key words: hypertension, diuretics, beta-blockers, angiotensin-converting enzyme inhibitors, calcium channel blockers.
