Summary
Recent outcome trials in patients above age 60 with systolo-diastolic hypertension are reviewed. The metaanalysis suggests that antihypertensive drug therapy can decrease cardiovascular and coronary mortality in selected patients. Based on these studies it is suggested that antihypertensive drug therapy is indicated in patients between age 60 and 75 when the diastolic pressure remains above 95 mmHg after repeated measurements. A target for systolic b.p. is not definitely established but a pressure of 150 mmHg may serve as a temporary proposal. Whether uncomplicated isolated systolic hypertension in symptomless patients should be treated is still under investigation.
References
World Health Organization. The uses of epidemiology in the study of the elderly. In: Report of a WHO Scientific Group on the Epidemiology of Aging. Technical Report Series. Geneva: WHO, 1974:706.
Shurtleff D. Some Characteristics Related to the Incidence of Cardiovascular Diseases and Death. The Framingham Study 18-Years Follow-Up. Washington, DC: U.S. Department of Health, Education and Welfare, NIH, 1974:74–599.
Amery A, Birkenhäger W, Brixko P, et al. Mortality and morbidity results from the European Working Party on High blood pressure in the Elderly. Lancet 1985;1:1349–1354.
Kuramoto K, Matsushita S, Kuwajima I, Murakawi M. Prospective study on the treatment of mild hypertension in the aged. Jpn Heart J 1981;22:75–85.
Amery A, Birkenhäger W, Brixko P. et al. Efficacy of antihypertensive drug treatment according to age, sex, blood pressure and previous cardiovascular disease in patients above the age of 60. Lancet 1986;2:589–592.
Coope J, Warrender TS. Randomized trial of treatment of hypertension in elderly patients. Br Med J 1986;293:1145–1151.
Dahlöf B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991;2(338):1281–1285.
MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: Principal results. Br Med J 1992;304:405–412.
Australian National Heart Foundation Management Committee. Treatment of mild hypertension in the elderly. Med J Aust 1981;2:398–402.
SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991;265:3255–3264.
Thijs L, Fagard R, Lijnen P, et al. A meta-analysis of outcome trials in elderly hypertensives. J Hypertens 1992, in press.
Staessen J, Fagard R, Amery A. Isolated systolic hypertension in the elderly: Implications of SHEP for clinical practice and for the ongoing trials (leading article). J Human Hypertens 1991;5:469–474.
Amery A, Birkenhäger W, Bulpitt C, et al. Syst-Eur. A multicentre trial on the treatment of isolated systolic hypertension in the elderly: Objectives, protocol and organisation. Aging 1991;3:287–302.
Staessen J, Amery A, Birkenhäger W, et al. Syst-Eur—a multicenter trial on the treatment of isolated systolic hypertension in the elderly: First interim report. J Cardiovasc Pharmacol 1992;19:120–125.
Staessen J, Bulpitt C, Clément D, et al. Relation between mortality and treated blood pressure in elderly patients with hypertension: Report of the European Working Party on High blood pressure in the Elderly. Br Med J 1989;298: 1552–1556.
Opie LH. Treatment of hypertension in the elderly—the end of the story? (editorial). Cardiovasc Drugs Ther 1992;6:559–562.
Fletcher A, Amery A, Birkenhäger W, et al. Risks and benefits in the trial of the European Working Party on High blood pressure in the Elderly. J Hypertens 1991;9:225–230.
Beard K, Bulpitt C, Mascio-Taylor H, et al. Management ofelderly patients with sustained hypertension. Br Med J 1992;304:412–416.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Amery, A., Birkenhäger, W.H., Fagard, R. et al. Treatment of the older hypertensive: Paradigms, practices, and proofs. Cardiovasc Drug Ther 6, 565–569 (1992). https://doi.org/10.1007/BF00052555
Issue Date:
DOI: https://doi.org/10.1007/BF00052555