Managing hypertension in the elderly: a common chronic disease with increasing age.

Background: Hypertension increases with age, affecting approximately 66% of the elderly population (aged ≥65 years). By the year 2030, 1 of 5 Americans will be aged ≥65 years. A number of placebo-controlled clinical trials have demonstrated that blood pressure (BP) control reduces cardiovascular events in elderly patients, even in those aged >80 years. Despite advances in medical care, hypertension control rates remain low, especially in the elderly population.

Objective: The goal of this article is to review the information that addresses hypertension in the elderly and current strategies that can facilitate improvement in the management of this common, chronic, and life-threatening condition, which is often undertreated or inappropriately managed.

Discussion: The goals and strategies of treating hypertension in the elderly population are different from, and more challenging than, those in younger patients. Lifestyle modification is effective in this population, but it is difficult to maintain. Many antihypertensive medications are available, with thiazide diuretics being the preferred first-line treatment. Beta-blockers and alpha-blockers are generally not recommended in this population. A majority of older patients will require 2 or 3 antihypertensive medications to reach BP goal. This article reviews current data on hypertensive treatment in the elderly and summarizes the strategies and challenges healthcare providers face when dealing with this population.

Conclusion: Understanding the strategies and challenges that apply to the management of hypertension in the US elderly population can help providers and payers better address the growing need for improving the management of this condition in the elderly, because their numbers are expected to increase dramatically in the coming decades.