MANAGEMENT OF HYPERTENSION IN OLDER PATIENTS

Reduction of hypertension, whether systolic and diastolic or isolated systolic, is associated with significant reductions in mortality and m orbidity rates even in older asymptomatic patients, particularly those less than 80 years old. The increased availability of antihypertensiv e preparations makes it possible to individualize the choice of therap y to meet the particular needs of the older patient. Although most pre sently available antihypertensive agents are effective, each one posse sses different properties and none is free of side effects. We review the indications for and the action and side effects of diuretics, angi otensin converting enzyme inhibitors, calcium channel blockers, and ad renergic blocking drugs, and we offer treatment suggestions for hypert ension associated with other diseases such as diabetes mellitus, heart failure, peripheral vascular insufficiency, depression, dementia, and urinary incontinence. Orthostatic hypotension is particularly serious in older patients because it may precipitate falls. It is also possib le that the relationship between blood pressure levels and mortality a nd morbidity risks is not linear but J-shaped, both low and high level s increasing risks. Caution in treating hypertensive elderly patients will minimize the incidence of side effects.