Hypertension in the elderly: definition, pathophysiology and prognostic implications of antihypertensive therapy

There is a high prevalence of arterial hypertension among elderly patients. Ln recent years, several prospective studies have documented a prognostic benefit of antihypertensive therapy in patients older than 70 years. In add ition, positive prognostic effects have been shown in patients with isolate d systolic hypertension. These results support the concept of a goal of ant hypertensive treatment of 140/90 mmHg for the elderly. Systolic blood pres sure and pulse pressure seem to be more closely related to cardiovascular m orbidity and mortality than mean or diastolic blood pressure. The absolute number of cardiovascular events prevented per 1000 patients treated is high er in elderly patients compared with younger hypertensives. Thus, the absol ute cardiovascular risk is an important indicator for the need of therapy i n this high-risk group of elderly patients. Further studies will investigat e if newer antihypertensive drugs with fewer sideeffects are especially sui table for the treatment of elderly hypertensives.