Pharmacotherapy for Hypertension in the Elderly

Treatment of hypertension is recommended for reducing mortality and cardiovascular and cerebrovascular morbidity in the elderly.

The recommendation is strong because of positive effect on patient important outcomes, and the cost of blood pressure medication is low.

A Cochrane review[Abstract] 1 included 16 studies with a total of 26 795 subjects 60 years or older (mean age 73.4 years) with moderate to severe systolic and/or diastolic hypertension (average 182/95 mmHg). A stepped care approach to hypertension treatment was applied in 13 studies. In over 70% of trials a thiazide diuretic was the first line drug; also beta blockers, calcium blockers, and ACE inhibitors were used. Second- and third-line drugs included diuretics, beta blockers, centrally acting antiadrenergic agents, peripherally acting antiadrenergic agents, vasodilators, converting-enzyme inhibitors, and calcium channel blockers. Length of study follow-up ranged from 1 to 6 years, a mean duration of treatment was 3.8 years.

Antihypertensive drug treatment reduced all-cause mortality, cardiovascular mortality and morbidity, cerebrovascular mortality and morbidity, and coronary heart disease mortality and morbidity (table T1). Withdrawals due to adverse effects were increased with treatment. Three studies were restricted to subjects with isolated systolic hypertension, and they reported similar benefits.

The reduction in mortality observed was due mostly to reduction in the 60-79-year-old patient subgroup. Although cardiovascular mortality and morbidity was significantly reduced in both subgroups 60-79 years old (RR 0.71, 95% CI 0.65 to 0.77) and 80 years or older (RR 0.75, 95% CI 0.65 to 0.87), the magnitude of absolute risk reduction was probably higher among 60-79-year-old patients (3.8% vs 2.9%). The reduction in cardiovascular mortality and morbidity was primarily due to a reduction in cerebrovascular mortality and morbidity.