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July 4, 1986, Vol 256, No. 1 >
ARTICLE | July 4, 1986

Statement on Hypertension in the Elderly FREE

[+] Author Affiliations

Final report of the working group to revise the April 1980 Elderly Statement, which in turn superseded the original document approved in September 1979.

Approved by the National High Blood Pressure Education Program on Sept 20, 1985.

Reprint requests to the National High Blood Pressure Education Program, Box J, 120/80 National Institutes of Health, Bethesda, MD 20892 (Edward J. Roccella, PhD, MPH).


JAMA. 1986;256(1):70-74. doi:10.1001/jama.1986.03380010074028
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References

Research indicates that isolated systolic hypertension, as well as diastolic hypertension, is associated with increased morbidity and mortality in people over age 65. According to data from the 1976 to 1980 National Health and Nutrition Examination Survey, the prevalence of these combined types of hypertension (≥140 /90 mm Hg) is estimated to be 64% in persons aged 65 to 74 years, with an even higher prevalence in blacks (76%) than in whites (63%). Although a number of studies have demonstrated the benefits of antihypertensive therapy in elderly patients, many questions unique to this population remain unanswered. This article addresses several of these issues and presents recommended guidelines on topics such as the pressure at which treatment should be initiated, goal pressure for people over age 65, antihypertensive drugs of choice and appropriate dosages, the accuracy of indirect measurements, side effects specific to elderly patients, and the effect of treatment on the quality of life.

(JAMA 1986;256:70-74)

REFERENCES

1 +
Kannel WB, Doyle JT, Ostfeld AM, et al:  Optimal resources for primary prevention of atherosclerotic diseases: Atherosclerosis Study Group . Circulation 1984;;70:153A-205A.
2 +
Drizd T, Dannenberg A, Engel A:  Blood pressure levels in persons 18-74 years of age in 1976-80, and trends in blood pressure from 1960-1980 in the United States . Vital Health Stat [11] 1986;, in press.
3 +
 Hypertension prevalence and the status of awareness, treatment, and control in the United States: Final report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee . Hypertension 1985;;7:457-458.
4 +
Freeman DH Jr, Ostfeld AM, Hellenbrand K, et al:  Changes in the prevalence distribution of hypertension: Connecticut adults 1978-79 to 1982 . J Chronic Dis 1985;;38:157-164.
5 +
Shekelle RB, Ostfeld AM, Klawans HL Jr:  Hypertension and risk of stroke in an elderly population . Stroke 1974;;5:71-75.
6 +
Curb JD, Borhani NO, Entwisle G, et al:  Isolated systolic hypertension in 14 communities . Am J Epidemiol 1985;;121:362-370.
7 +
Garland C, Barrett-Connor E, Suarez L, et al:  Isolated systolic hypertension and mortality after age 60 years: A prospective population-based study . Am J Epidemiol 1983;;118:365-376.
8 +
 Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program: II. Mortality by race-sex and age . JAMA 1979;; 242:2572-2577.
9 +
 National Heart Foundation of Australia: Treatment of mild hypertension in the elderly: Report by the Management Committee . Med J Aust 1981;;2:398-402.
10 +
 Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program: III. Reduction in stroke incidence among persons with high blood pressure . JAMA 1982;;247:633-638.
11 +
Amery A, Birkenhäger W, Brixko P, et al:  Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial . Lancet 1985;;1:1349-1354.
12 +
Kannel WB:  Some lessons in cardiovascular epidemiology from Framingham . Am J Cardiol 1976;;37:269-282.
13 +
Kannel WB:  Implications of Framingham study data for treatment of hypertension: Impact of other risk factors , in Laragh JH, Buhler FR, Seldin DW (eds): Frontiers in Hypertension Research . New York, Springer-Verlag NY Inc, 1981;, pp 17-21.
14 +
Blood Pressure Study 1979 . Chicago, Society of Actuaries and Association of Life Insurance Medical Directors of America, 1980;.
15 +
Hulley SB, Furberg CD, Gurland B, et al:  Systolic Hypertension in the Elderly Program (SHEP): Antihypertensive efficacy of chlorthalidone . Am J Cardiol 1985;;56:913-920.
16 +
O'Callaghan WG, Fitzgerald DJ, O'Malley K, et al:  Accuracy of indirect blood pressure measurement in the elderly . Br Med J Clin Res 1983;; 286:1545-1546.
17 +
 The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med 1984;; 144:1045-1057
18 +
J Am Osteopath Assoc 1984;;83:642-659.
19 +
Lipsitz LA, Nyquist RP Jr, Wei JY, et al:  Postprandial reduction in blood pressure in the elderly . N Engl J Med 1983;;309:81-83.
20 +
Bühler FR, Bolli P, Kiowski W, et al:  Renin profiling to select antihypertensive baseline drugs: Renin inhibitors for high-renin and calcium entry blockers for low-renin patients . Am J Med 1984;; 77:36-42.
21 +
Curb JD, Borhani NO, Blaszkowski TP, et al:  Long-term surveillance for adverse effects of antihypertensive drugs . JAMA 1985;;253:3263-3268.
22 +
Ostrom JS, Hammarlund ER, Christensen DB, et al:  Medication usage in an elderly population . Med Care 1985;;23:157-164.
23 +
Branch LG:  Functional abilities of the elderly: An update on the Massachusetts Health Care Panel Study , in Haynes SG, Feinleib M (eds): Second Conference on the Epidemiology of Aging: Proceedings . National Institute on Aging and National Heart, Lung, and Blood Institute, 1980;, pp 237-265.
24 +
Ascione FJ, Brown GH, Kirking DM:  Evaluation of a medication refill reminder system for a community pharmacy . Patient Educ Counseling 1985;;7:157-165.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Kannel WB, Doyle JT, Ostfeld AM, et al:  Optimal resources for primary prevention of atherosclerotic diseases: Atherosclerosis Study Group . Circulation 1984;;70:153A-205A.
2 +
Drizd T, Dannenberg A, Engel A:  Blood pressure levels in persons 18-74 years of age in 1976-80, and trends in blood pressure from 1960-1980 in the United States . Vital Health Stat [11] 1986;, in press.
3 +
 Hypertension prevalence and the status of awareness, treatment, and control in the United States: Final report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee . Hypertension 1985;;7:457-458.
4 +
Freeman DH Jr, Ostfeld AM, Hellenbrand K, et al:  Changes in the prevalence distribution of hypertension: Connecticut adults 1978-79 to 1982 . J Chronic Dis 1985;;38:157-164.
5 +
Shekelle RB, Ostfeld AM, Klawans HL Jr:  Hypertension and risk of stroke in an elderly population . Stroke 1974;;5:71-75.
6 +
Curb JD, Borhani NO, Entwisle G, et al:  Isolated systolic hypertension in 14 communities . Am J Epidemiol 1985;;121:362-370.
7 +
Garland C, Barrett-Connor E, Suarez L, et al:  Isolated systolic hypertension and mortality after age 60 years: A prospective population-based study . Am J Epidemiol 1983;;118:365-376.
8 +
 Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program: II. Mortality by race-sex and age . JAMA 1979;; 242:2572-2577.
9 +
 National Heart Foundation of Australia: Treatment of mild hypertension in the elderly: Report by the Management Committee . Med J Aust 1981;;2:398-402.
10 +
 Hypertension Detection and Follow-up Program Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program: III. Reduction in stroke incidence among persons with high blood pressure . JAMA 1982;;247:633-638.
11 +
Amery A, Birkenhäger W, Brixko P, et al:  Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial . Lancet 1985;;1:1349-1354.
12 +
Kannel WB:  Some lessons in cardiovascular epidemiology from Framingham . Am J Cardiol 1976;;37:269-282.
13 +
Kannel WB:  Implications of Framingham study data for treatment of hypertension: Impact of other risk factors , in Laragh JH, Buhler FR, Seldin DW (eds): Frontiers in Hypertension Research . New York, Springer-Verlag NY Inc, 1981;, pp 17-21.
14 +
Blood Pressure Study 1979 . Chicago, Society of Actuaries and Association of Life Insurance Medical Directors of America, 1980;.
15 +
Hulley SB, Furberg CD, Gurland B, et al:  Systolic Hypertension in the Elderly Program (SHEP): Antihypertensive efficacy of chlorthalidone . Am J Cardiol 1985;;56:913-920.
16 +
O'Callaghan WG, Fitzgerald DJ, O'Malley K, et al:  Accuracy of indirect blood pressure measurement in the elderly . Br Med J Clin Res 1983;; 286:1545-1546.
17 +
 The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure . Arch Intern Med 1984;; 144:1045-1057
18 +
J Am Osteopath Assoc 1984;;83:642-659.
19 +
Lipsitz LA, Nyquist RP Jr, Wei JY, et al:  Postprandial reduction in blood pressure in the elderly . N Engl J Med 1983;;309:81-83.
20 +
Bühler FR, Bolli P, Kiowski W, et al:  Renin profiling to select antihypertensive baseline drugs: Renin inhibitors for high-renin and calcium entry blockers for low-renin patients . Am J Med 1984;; 77:36-42.
21 +
Curb JD, Borhani NO, Blaszkowski TP, et al:  Long-term surveillance for adverse effects of antihypertensive drugs . JAMA 1985;;253:3263-3268.
22 +
Ostrom JS, Hammarlund ER, Christensen DB, et al:  Medication usage in an elderly population . Med Care 1985;;23:157-164.
23 +
Branch LG:  Functional abilities of the elderly: An update on the Massachusetts Health Care Panel Study , in Haynes SG, Feinleib M (eds): Second Conference on the Epidemiology of Aging: Proceedings . National Institute on Aging and National Heart, Lung, and Blood Institute, 1980;, pp 237-265.
24 +
Ascione FJ, Brown GH, Kirking DM:  Evaluation of a medication refill reminder system for a community pharmacy . Patient Educ Counseling 1985;;7:157-165.

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