M. Faisal Jhandir, MD, RVT, Clinical Assistant Professor of Medicine, Co-Chair Vascular Risk Reduction Program, University of Calgary, Calgary, AB.
Robert J. Herman, MD, FRCPC, Professor of Medicine, Head, Division of General Internal Medicine, University of Calgary, Calgary, AB.
Norm R.C. Campbell, MD, FRCPC, Professor of Medicine, Physiology and Pharmacology and Community Health Sciences, University of Calgary and Libin Cardiovascular Institute, Calgary, AB.

The World Health Organization has named hypertension the leading risk for death globally in adults. Antihypertensive therapy reduces the risks of major cardiovascular complications. As blood pressure increases with increasing age, frequent screening for hypertension is advisable in older adults. The risk of developing hypertension is about 90% even in normotensive 65 year olds. Until recently, data supporting antihypertensive therapy in the very old had been inconclusive. However, the HYVET trial published in 2008 shows a clear reduction in cardiovascular events and mortality. Based on this study the Canadian Hypertension Education Program recommends treating hypertension regardless of age. Attention should also be given to reducing overall cardiovascular risk.
Key words: hypertension, high blood pressure, older adults, recommendations, HYVET study.

Norm R.C. Campbell, MD, FRCPC, Division of General Internal Medicine, University of Calgary, Calgary, AB.
J. George Fodor, MD, FRCPS, PhD, Ottawa Heart Institute, Ottawa, ON.
Robert Herman, MD, FRCPC, Division of General Internal Medicine, University of Calgary, Calgary, AB.
Pavel Hamet, MD, FRCPC, PhD, Research Center, CHUM, Montréal, QC (for the Canadian Hypertension Education Program).

Hypertension is a leading risk for morbidity and mortality in Canada. The older population is at greater risk from hypertension and has a greater reduction in cardiovascular risk with treatment than young patients. Frequent screening for hypertension is prudent as the estimated risk of developing hypertension is about 90%, even in normotensive 65-year-olds. Systolic blood pressure is a more relevant risk factor than diastolic blood pressure in older patients and is more difficult to treat to target. Most hypertensive patients will have multiple cardiovascular risks that require screening and management to reduce cardiovascular risk optimally. Lifestyle therapy is efficacious. Effective first-line drug therapies that reduce hypertension complications include thiazide-type diuretics, ACE inhibitors, long-acting calcium-channel blockers, and angiotensin-receptor blockers. Most patients require two or more drugs to achieve current blood pressure targets.
Key words: high blood pressure, hypertension, guidelines, recommendations, evidence-based medicine.

Rory H. Fisher, MB, FRCP(Ed)(C), Director, The Regional Geriatric Program of Toronto and Interdepartmental Division of Geriatrics, Faculty of Medicine, University of Toronto, Toronto, ON.

The impact of the Romanow Report on the elderly is reviewed here. Recommendations for a Health Council, modernization of the Canada Health Act, improved home care and a National Drug Agency would benefit all elderly Canadians. However, the current unmet needs of the elderly, the value of specialized geriatric services and the developments in other jurisdictions are not recognized. The Romanow Commission fails senior citizens by ignoring their current unmet needs.
Key words: Romanow Report, recommendations, elderly.