Antihypertensive therapy in the elderly: The results of large trials

The aim of this review was to evaluate if antihypertensive treatment in elderly hypertensive patients is able to lower the incidence of cardiovascular events when compared to hypertensive controls who received placebo. All trials agree in that the greater blood pressure reduction in hypertensive patients randomized to active treatment is associated with a minor incidence of cerebrovascular, cardiac and all cardiovascular events in comparison to placebo-treated control groups. Therefore the chronic antihypertensive treatment makes more good than bad. All antihypertensive agents have been used for the treatment of arterial hypertension in the elderly and all have shown a good efficacy and tolerability, even if, as in the adult hypertensives, the combination of two or more agents is necessary in the great majority of hypertensive patients to reach the target blood pressure. Because life expectancy is progressively longer and the prevalence of hypertension, in particular isolated systolic hypertension, is age-dependent, it is clinically relevant to investigate if there is an upper limit for the benefit of antihypertensive therapy. The results so far available suggest a benefit up to the age of 80 years, while an ongoing study is aimed at evaluating the benefit of antihypertensive therapy in patients > 80 years. Finally, according to our personal point of view, there are sufficient data to sustain the indication of a diastolic blood pressure reduction between 80 and 90 mmHg, while the indication to a reduction in systolic blood pressure below 140 mmHg is less strong and supported.