Description

Increasing blood pressure (BP) levels, at least in those aged up to 90 years, are associated with a greater risk of developing cardiovascular (CV) disease. However, hypertension is still under-diagnosed, poorly treated and inadequately controlled in older people. To fully reduce the burden of stroke and myocardial infarction (MI) it is important to deal with other CV risk factors as well as hypertension, a patients overall CV risk being easily calculated using the new Joint British Societies risk charts. Up to 80 years of age, those with sustained clinic systolic blood pressure (SBP) ≥ 160 and/or diastolic blood pressure (DBP) ≥100 mmHg should be considered for antihypertensive treatment, to include lifestyle changes, irrespective of other CV risk factors. If BP is 140-159/ 90-99 mmHg the need for anti-hypertensive therapy depends on overall CV risk, if ≥20% over 10 years then treatment should be instituted. Low dose thiazide diuretics or dihydropyridine calcium channel blockers (CCB) are suitable first line agents with the addition of an angiotensin converting enzyme inhibitor (ACEI) or angiotensin-II receptor blocker (ARB) if BP control remains inadequate. Those with a CV risk ≥20% over 10 years should also be considered for statin therapy if total cholesterol levels are >3.5 mmol/l and prophylactic aspirin introduced once BP is controlled. Lower BP thresholds (≥130/80 mmHg) for starting therapy are necessary in diabetic patients or those with target organ damage (TOD). For patients > 80 years, guidelines are unclear, but for those already on antihypertensive treatment this should probably be continued, and, for those newly diagnosed with evidence of diabetes or TOD anti-hypertensive treatment initiated.