Hypertension in the elderly
The prevalence of hypertension rises with age. Hypertension in an independent risk factor for coronary artery disease, ischemic cerebrovascular disease, intracerebral hemorrhage, aortic aneurysm, congestive heart failure, and peripheral vascular disease both in middle-aged patients and in those over 65.
Recent intervention trials in patients up to age 69 have demonstrated significant reduction in morbidity and mortality when hypertension is effectively treated. Thus, therapy should be initiated for diastolic blood pressures greater than 90 mm Hg and systolic blood pressures greater than 160 mm Hg as measured on at least three separate occasions, especially if associated with additional risk factors for cardiovascular disease. Reduction of blood pressure below these levels is likely to reduce the incidence of subsequent complications. In addition, blood pressure reduction will lessen symptoms of angina pectoris, congestive heart failure, aortic regurgitation, and mitral regurgitation. Recent evidence suggests that therapy may also reduce morbidity in isolated systolic hypertension. Epidemiologic evidence points to an increased incidence of cerebrovascular complications in these patients and therefore encourages treatment in most cases.