Treatment of Hypertension in Older Adults

Wilbert S. Aronow, MD, FACC, FAHA, AGSF


Geriatrics and Aging. 2008;11(8):457-463. 

In This Article

Abstract and Introduction


Numerous double-blind, randomized, placebo-controlled studies have documented that antihypertensive drug therapy reduces cardiovascular events in older adults. In the Hypertension in the Very Elderly Trial, individuals 80 years of age and older treated with antihypertensive drug therapy had, at 1.8-year follow-up, a 30% reduction in fatal or nonfatal stroke, a 39% reduction in fatal stroke, a 21% reduction in all-cause mortality (p=0.02), a 23% reduction in death from cardiovascular causes, and a 64% reduction in heart failure. The goal of treatment of hypertension in older adults is to reduce the blood pressure to <140/90 mmHg and to <130/80 mmHg in older persons with diabetes or chronic renal insufficiency. Older adults with diastolic hypertension should have their diastolic blood pressure reduced to 80-85 mmHg. Diuretics should be used as initial therapy in persons with no associated medical conditions. The selection of antihypertensive drug therapy in persons with associated medical conditions depends on their medical conditions. If the blood pressure is >20/10 mmHg above the goal blood pressure, drug therapy should be initiated with two antihypertensive drugs, one of which should be a thiazide-type diuretic. Other coronary risk factors must be treated.


An 81-year-old man with a prior myocardial infarction had a sitting blood pressure of 174/90 mm Hg in the right brachial artery and 172/88 mm Hg in the left brachial artery. His standing blood pressures were similar. His physician was uncertain whether he should treat his patient's blood pressure because of different published opinions[1,2] and because of a debate he had heard at a national meeting moderated by the author in which conflicting opinions were expressed. Should this man be treated with antihypertensive drug therapy? Yes.[3,4] This article will discuss why.


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