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Management of hypertension in the elderly patient
Clinical Interventions in Aging, 10/01/09

Stokes GS – The prime objective of this therapy is to prevent stroke. The findings of controlled trials show that there should be no cut–off age for treatment. A holistic program for controlling cardiovascular risks should be fully discussed with the patient, including evaluation to exclude underlying causes of secondary hypertension, and implementation of lifestyle measures. The choice of antihypertensive drug therapy is influenced by concomitant disease and previous medication history, but will typically include a thiazide diuretic as the first–line agent; to this will be added an angiotensin inhibitor and/or a calcium channel blocker. Beta blockers are not generally recommended, in part because they do not combat the effects of increased arterial stiffness. The hypertension–hypotension syndrome requires case–specific management. Drug–resistant hypertension is important to differentiate from faulty compliance with medication. Patients resistant to third–line drug therapy may benefit from treatment with extended–release isosorbide mononitrate. A trial of spironolactone may also be worthwhile.

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