Hypertension in the elderly.

Based on the best evidence we have currently, treating the elderly patient with diastolic hypertension will significantly decrease the risk of stroke. While the evidence for decreasing the risks of coronary disease, congestive heart failure, renal insufficiency, or total mortality is not present, such evidence does exist in younger patients with more severe hypertension. Thus, it is of benefit to reduce the blood pressure in hypertensive older patients. There is some evidence that the elderly may not be more susceptible to side effects of antihypertensive medications than younger populations. However, it is certainly reasonable to attempt blood pressure control by nonpharmacologic means prior to drug treatment. Demographic considerations may affect the choice of medication; in general the stepped-care approach will provide effective management of elevated blood pressure in this population.