HYPERTENSION IN WOMEN AND THE ELDERLY - SOME PUZZLING AND SOME EXPECTED FINDINGS OF TREATMENT STUDIES

Almost 65% of the US population over age 60 has hypertension (systolic blood pressure greater than or equal to 140 mm Hg or diastolic blood pressure greater than or equal to 90 mm Hg), which is strongly related to increased rates of coronary artery disease (CAD), stroke, and deat h, The need for treatment seems obvious. However, in young and middle- aged women, treatment is not straightforward, and trials have not spec ifically targeted this group. Data extrapolated from existing studies suggest that treatment of hypertension does not confer tbe same protec tion against CAD and stroke in women as it does in men, In fact, a tre nd toward harm in young and middle-aged white women receiving stepped care for hypertension has been reported, Therefore, for now, treatment of women in this age-group should be conservative; drugs should be pr escribed only after a focused trial of lifestyle modification has fail ed. Until recently, elderly subjects were also excluded from treatment studies, despite the fact that they are at high risk for morbidity an d death fi om hypertension-related diseases. Recent studies have estab lished that treatment of hypertension in the elderly is extremely effe ctive, that elderly women should be treated as aggressively as elderly men, and that low-dose diuretic or beta-blocker therapy should be ini tiated if lifestyle modifications are not effective.