Description

Increasing systolic blood pressure is associated with cardiovascular disease and mortality in elderly and probably very elderly (>85years) adults. The association of diastolic blood pressure with cardiovascular disease is probably not linear in older adults. A wide pulse pressure reflecting arterial stiffness and/or atherosclerosis may be more strongly associated with cardiovascular disease mortality and morbidity than either SBP or DBP alone. Several intervention trials have confirmed lower cardiovascular disease risk in subjects aged into their early 80s with SBP >160 mmHg and/or DBP >90 mmHg when treated with a variety of antihypertensive drugs. There is some limited evidence to suggest that beta-blockers may not be as effective as thiazide diuretics in reducing coronary heart disease or total mortality in the elderly. However, thiazide or thiazide beta-blocker based regimens appear to be of similar efficacy as newer agents such as calcium channel blockers and angiotensin converting enzyme inhibitors. In the subjects recruited into large outcome trials most antihypertensive drugs were well tolerated. There was no evidence that drug therapy and/or lowering of blood pressure lead to any significant deterioration in quality of life. Aiming to lower SBP to <150 mmHg and DBP <85 mmHg is considered desirable although

tighter controls (SBP <140 and DBP <80 mmHg) in patients at high risk of vascular disease such as those with diabetes is recommended. Priority for treatment is aimed at patients having a high risk of vascular disease, ie, those with existing cardiovascular disease, patients with diabetes or having multiple risk factors such that their cardiovascular disease risk is (40% /10 years. Intervention in these patients should be considered with antihypertensive drugs if SBP >140 mmHg and/or DBP >90 mmHg; other therapies to lower cardiovascular disease risk should be considered, e.g, cholesterol lowering, aspirin etc. A more aggressive approach to treating cardiovascular risk factors should lead to a reduction in the high burden of vascular disease seen in older people.