Hypertensive cardiovascular disease and the treatment of hypertension in the elderly.

Hypertension affects most elderly Americans. In eight major randomized, controlled trials evaluating the treatment of hypertension in the elderly, drug therapy for high blood pressure (including isolated systolic hypertension) has been shown to prevent fatal and nonfatal strokes and coronary events. The relative reduction in strokes was greater than that seen in coronary events. An analysis of the combined data shows that the treatment of hypertension in the elderly also reduces mortality from stroke, coronary heart disease, and all causes. All of these major clinical trials used primarily diuretics and beta-blockers. Low-dose diuretics may be superior to beta-blockers in the elderly; however, reliable comparisons of these and other antihypertensive agents in terms of cardiovascular risk reduction are not yet available. Limited comparisons on the efficacy of blood pressure-lowering and patient tolerance characteristics are reviewed.