HYPERTENSION IN THE ELDERLY

In those aged 65-85 years, the major causes of death and disability ar e cardiovascular diseases (myocardial infarction, sudden death and str oke). Clinical trials in elderly patients have demonstrated unequivoca lly that effective blood pressure reduction in hypertensive patients u p to the age of 85 years significantly reduces this mortality and morb idity. The larger trials are referred to as the SHEP trial (chlorthali done), the STOP trial (beta-blockers and/or diuretics), the MRC Elderl y Trial (atenolol or diuretic) and the SYST-EUR trial (nitrendipine). Patients entered into clinical trials are a selected population; those with serious coexisting diseases and with a poor prognosis are usuall y excluded. For this reason one has to carefully consider whether the results of these trials would provide the best treatment for the next patient the doctor sees who would probably not meet the entry criteria . Elderly hypertensives may fall into one of three categories. The sic k elderly with serious disorders such as cancer or dementia have a poo r quality of life and a bad prognosis. They should not be given antihy pertensive drugs. The medically complicated elderly have serious disor ders, which usually require drug therapy and the medical condition and the drugs used in treatment may complicate the choice of antihyperten sive drugs. The potential adverse effects of adding another form of dr ug treatment may outweigh the potential benefits. The fit elderly do d erive considerable benefit from adequate blood pressure control and ne ed an effective, well-tolerated antihypertensive drug. The choice of d rug to control blood pressure in the elderly is difficult. An effectiv e, well-tolerated antihypertensive with little potential to interact w ith coexisting disorders and other drugs is needed.