MANAGING THE ELDERLY HYPERTENSIVE PATIENT BEYOND BLOOD-PRESSURE REDUCTION

Antihypertensive treatment of the elderly: Several prospective, random ized, long-term trials on antihypertensive drug treatment have shown t hat elderly patients with systolic and diastolic or isolated systolic hypertension benefit from a reduction in blood pressure. Antihypertens ive treatment reduces the overall mortality by 20%, cardiovascular mor tality by 33%, the incidence of fatal and non-fatal cerebrovascular ev ents by 40% and the complications of coronary heart disease by 15%. In addition, elderly patients have a high risk of overt or latent and as ymptomatic cardiovascular diseases. For this reason, not only antihype rtensive treatment, but also risk factor modification (such as cholest erol reduction therapy) is, in absolute terms, more beneficial in elde rly patients than in middle-aged patients, particularly in patients wi th concomitant cardiovascular diseases and other risk factors. Quality of life: Although the randomized trials have focused on mortality and morbidity as main endpoints, it is questionable whether longevity is a worthwhile social objective in itself. Quality of life is an importa nt aspect of antihypertensive treatment, since hypertension is general ly symptomless while drug therapy may have adverse effects on the qual ity of life. The frequency of adverse effects is similar in both middl e-aged and elderly hypertensive patients, with about 2% of patients pe r year in both age groups withdrawing from randomized treatment due to objectively assessed adverse effects. The rate of subjectively assess ed adverse effects during treatment is also similar in younger and eld erly patients. In general, clinical studies have suggested that a bloo d pressure reduction does not influence the well-being of elderly pati ents, whether measured in physical, emotional or social terms. Both ca lcium antagonists and diuretics have shown an age-dependent effect in comparative trials, with a higher blood pressure reduction in elderly than in younger patients. Conclusion: Antihypertensive therapy in elde rly hypertensives adds longevity and need not compromise quality of li fe. Although the reduction and normalization of blood pressure is the primary goal, the increased availability of antihypertensive preparati ons and drugs for treating concomitant diseases and risk factors allow s the physician to tailor treatment of the elderly to the needs of the individual patient.