Is it advantageous to lower cholesterol in the elderly hypertensive?

Hypertension is often associated with other risk factors for cardiovascular disease, including elevated levels of cholesterol, and casual systolic hyp ertension is a very prevalent finding in the elderly (50% of women over the age of 80 have casual systolic blood pressures greater than or equal to 16 0 mmHg). Total cholesterol levels steadily increase with age from 20 to 65, following which they decrease slightly in men and tend to plateau in women . Elevated cholesterol levels are not uncommon in the elderly (61% of women aged between 65 and 74 have total cholesterol levels over 6.2 mmol/L [240 mg/dL]). From the data available, it is reasonable to conclude that after t he age of 65, increased blood lipids, although still a risk factor for coro nary heart disease (CHD), become less pronounced as risk factors and that b y 75 years of age their predictive value has disappeared. Indeed, in the ve ry elderly, there is evidence to suggest that high total cholesterol is ass ociated with longevity. In elderly hypertensives with elevated serum choles terol, differing risks have been reported. The European Working Party on Hy pertension in the Elderly (EWPHE) trial suggested a negative relationship b etween cholesterol and mortality, while the Systolic Hypertension in the El derly Program (SMEP) trial suggested a positive relationship. With regards to intervention, it is well documented that antihypertensive t reatment in elderly hypertensives up to the age of 80 who have blood pressu res over 160 mmHg systolic is associated with significant reductions in str oke and cardiovascular events. The efficacy of dietary modification in redu cing cholesterol in the elderly has been supported by some studies but not by all. Three major intervention trails using statins have shown that in el derly patients up to the age of 70-75 who have established CHD, lipid-lower ing therapy can be of benefit. The experience from these and other trials s uggests that statins are generally well tolerated in the elderly. It is dif ficult and premature to extrapolate these results to elderly patients who h ave hypertension and raised cholesterol levels without established CHD. Fur ther trials are required before routinely suggesting it is advantageous to lower cholesterol in an elderly hypertensive who does not have pre-existing evidence of CHD. It is possible that large numbers may prove to require tr eatment.