Does the benefit of antihypertensive treatment outweigh the risk in very elderly hypertensive patients?

The risk of hypertension and the benefits of antihypertensive treatment are well established in order patients aged up to 80 years. For people aged 85 and over, data are scarce and conflicting. A positive association between blood pressure and survival has been found in several cohort studies; this relationship held true after adjustment for many factors in some studies, b ut disappeared after adjustment for indicators of poor health in others. In randomized trials, the benefit of antihypertensive treatment was demonstra ted in the Systolic Hypertension in the Elderly Program (SHEP) study, but i t declined with age and was not observable after 80 years in the European W orking Party on High Blood Pressure in the Elderly (EWPHE) study. The SYSTo lic hypertension in elderly in EURope Trial (SYST-EUR) study evidenced a be nefit on cardiovascular morbidity but not on mortality. People who reach a very old age share some characteristics that make them different from those '60 (or 65) and over' and justify special studies which are currently in p rogress. In the meantime, any treatment decision can only rely on extrapola tions moderated by com mon sense, but the already demonstrated favorable re sults on morbidity argue against a threshold beyond which hypertension shou ld not be treated. (C) 2000 Lippincott Williams & Wilkins.