Abstract
There is a high prevalence of systemic arterial hypertension in the elderly; 70% of
adults >65 years have this disease. A key mechanism in the development of hypertension
in the elderly is increased arterial stiffness. This accounts for the increase in
systolic blood pressure and pulse pressure and fall in diastolic blood pressure (isolated
systolic hypertension) that are commonly seen in the elderly, compared with younger
persons. The diagnosis of hypertension is made on the basis of in-office blood pressure
measurements together with ambulatory and home blood pressure recordings. Lifestyle
changes are the cornerstone of management of hypertension.
Comprehensive guidelines regarding blood pressure threshold at which to start pharmacotherapy
as well as target blood pressure levels have been issued by both European and American
professional bodies. In recent years, there has been considerable interest in intensive
lowering of blood pressure in older patients with hypertension. Several large, randomized
controlled trials have suggested that a strategy of aiming for a target systolic blood
pressure of <120 mm Hg (intensive treatment) rather than a target of <140 mm Hg (standard
treatment) results in significant reduction in the incidence of adverse cardiovascular
events and total mortality. A systolic blood pressure treatment of <130 mm Hg should
be considered favorably in non-institutionalized, ambulatory, free living older patients.
In contrast, in the older patient with a high burden of comorbidities and limited
life expectancy, an individualized team-based approach, based on clinical judgment
and patient preference should be adopted. An increasing body of evidence for older
adults with hypertension suggests that intensive blood pressure lowering may prevent
or at least partially prevent cognitive decline.
Keywords
hypertension - elderly patient - arterial stiffness - intensive blood pressure lowering
- mild cognitive impairment - pseudohypertension
