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August 22, 1990, Vol 264, No. 8 >
ARTICLE | August 22, 1990

Treatment of Hypertension in the Elderly FREE

Hong I. Tjoa, MD; Norman M. Kaplan, MD
[+] Author Affiliations

This article is one of a series sponsored by the American Heart Association.

Reprint requests to Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-8852 (Dr Kaplan).


JAMA. 1990;264(8):1015-1018. doi:10.1001/jama.1990.03450080101040
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References

Hypertension, both combined diastolic plus systolic and isolated systolic, is common in the elderly. Elderly hypertensive patients pose a number of diagnostic dilemmas, including pseudohypertension, postural and postprandial decreases in blood pressure, and the potential for renovascular hypertension. Data from large clinical trials have documented protection from cardiovascular complications by antihypertensive therapy for elderly people with combined systolic and diastolic hypertension. However, no data are available concerning the value of therapy for those with isolated systolic hypertension. Until such data become available from the Systolic Hypertension in the Elderly Program in 1991, cautious reduction of elevated systolic blood pressure levels is recommended. The fragile physiologic characteristics of the elderly demand caution and gentleness in the use of any therapy to lower blood pressure. Nondrug therapies are safe and may be effective. A variety of drugs are available and can be used to gradually reduce blood pressure to presumably safer levels.

(JAMA. 1990;264:1015-1018)

REFERENCES

1 +
Havlik RJ, LaCroix AZ, Kleinman JC, Ingram DD, Harris T, Cornoni-Huntley J.  Antihypertensive drug therapy and survival by treatment status in a national survey . Hypertension . 1989;;13( (suppl I) ):I28-I32.
2 +
Working Group on Hypertension in the Elderly.  Statement on hypertension in the elderly . JAMA . 1986;;256:70-74.
3 +
Kannel WB.  Risk factors in hypertension . J Cardiovasc Pharmacol . 1989;;13( (suppl 1) ):S4-S10.
4 +
Bauer GE.  Treatment of hypertension in the elderly . Drugs . 1974;:7:310-318.
5 +
1988 Joint National Committee.  The 1988 report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure . Arch Intern Med . 1988;;148:1023-1038.
6 +
 1989 Guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting . J Hypertens . 1989;;7:689-693.
7 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  Effects of treatment on morbidity in hypertension, II: results in patients with diastolic blood pressure averaging 90 through 114 mm Hg . JAMA . 1970;;213:1143-1152.
8 +
Management Committee.  The Australian therapeutic trial in mild hypertension . Lancet . 1980;; 1:1261-1267.
9 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program . JAMA . 1979;;242:2562-2571.
10 +
Amery A, Birkenhager 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.
11 +
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.
12 +
Goldstein G, Materson BJ, Cushman WC, et al.  Treatment of hypertension in the elderly, II: cognitive and behavioral function: results of a Department of Veterans Affairs Cooperative Study . Hypertension . 1990;;15:361-369.
13 +
Caird FI, Andrews GR, Kennedy RD.  Effect of posture on blood pressure in the elderly . Br Heart J . 1973;;35:527-530.
14 +
Goldstein IB, Shaprio D.  Cardiovascular response during postural change in the elderly . J Gerontol . 1990;;45:M20-M25.
15 +
Peitzman SJ, Berger SR.  Postprandial blood pressure decrease in well elderly persons . Arch Intern Med . 1989;;149:286-288.
16 +
Wilcox CS, Williams CM, Smith TB, Frederickson ED, Wingo C, Bucci CM.  Diagnostic uses of angiotensin-converting enzyme inhibitors in renovascular hypertension . Am J Hypertens . 1988;;1: 344S-349S.
17 +
Pearson AC, Gudipati CV, Labovitz AJ.  Systolic and diastolic flow abnormalities in elderly patients with hypertensive hypertrophic cardiomyopathy . J Am Coll Cardiol . 1988;;12:989-995.
18 +
Niarchos AP, Laragh JH.  Effects of diuretic therapy in low-, normal- and high-renin isolated systolic systemic hypertension . Am J Cardiol . 1984;;53:797-801.
19 +
West LJ, Maxwell DS, Noble EP, Solomon DH.  Alcoholism and aging . Ann Intern Med . 1984;;100:405-416.
20 +
Stuart EM, Deckro JP, Mamish ME, Friedman R, Benson H.  Non-pharmacologic treatment of the elderly hypertensive patient . Circulation . 1989;; 80( (suppl II) ):189.
21 +
Evans CE, Haynes RB, Goldsmith CH, Hewson SA.  Home blood pressure-measuring devices: a comparative study of accuracy . J Hypertens . 1989;;7:133-142.
22 +
Kaplan NM.  Critical comments on recent literature: age and the response to antihypertensive drugs . Am J Hypertens . 1989;;2:213-215.
23 +
Materson BJ, Cushman WC, Goldstein G, et al.  Treatment of hypertension in the elderly, I: blood pressure and clinical changes: results of a Department of Veterans Affairs Cooperative Study . Hypertension . 1990;;15:348-360.
24 +
Freis ED.  Age and antihypertensive drugs: (hydrochlorothiazide, bendroflumethiazide, nadolol and captopril) . Am J Cardiol . 1988;;61:117-121.
25 +
Wikstrand J, Westergren G, Berglund G, et al.  Antihypertensive treatment with metoprolol or hydrochlorothazide in patients aged 60 to 75 years . JAMA . 1986;;255:1304-1310.
26 +
Abernathy DR, Schwartz JB, Plachetka JR, Todd EL, Egan JM.  Comparison in young and elderly patients of pharmacodynamics and disposition of labetalol in systemic hypertension . Am J Cardiol . 1987;;60:697-702.
27 +
Ram CVS, Meese R, Kaplan NM, et al.  Antihypertensive therapy in the elderly: effects on blood pressure and cerebral blood flow . Am J Med . 1987;; 82( (suppl 1A) ):53-57.
28 +
Kaplan NM.  Calcium entry blockers in the treatment of hypertension: current status and future prospects . JAMA . 1989;;262:817-823.
29 +
Lichtlen PR, Hugenholtz PG, Rafflenbeul W, et al.  Retardation of angiographic progression of coronary artery disease by nifedipine: results of the International Nifedipine Trial on Antiatherosclerotic Therapy (INTACT) . Lancet . 1990;;335:1109-1113.
30 +
Yusuf S, Wittes J, Friedman L.  Overview of results of randomized clinical trials in heart disease, I: treatments following myocardial infarction . JAMA . 1988;;260:2088-2093.
31 +
Leonetti G.  The clinical performance of nicardipine in elderly hypertensive patients with concomitant diseases . Am Heart J . 1989;;117:266-269.
32 +
Mulinari R, Gavras I, Gavras H.  Efficacy and tolerability of enalapril monotherapy in mild to moderate hypertension in older patients compared to younger patients . Clin Ther . 1987;;9:678-689.

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

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1 +
Havlik RJ, LaCroix AZ, Kleinman JC, Ingram DD, Harris T, Cornoni-Huntley J.  Antihypertensive drug therapy and survival by treatment status in a national survey . Hypertension . 1989;;13( (suppl I) ):I28-I32.
2 +
Working Group on Hypertension in the Elderly.  Statement on hypertension in the elderly . JAMA . 1986;;256:70-74.
3 +
Kannel WB.  Risk factors in hypertension . J Cardiovasc Pharmacol . 1989;;13( (suppl 1) ):S4-S10.
4 +
Bauer GE.  Treatment of hypertension in the elderly . Drugs . 1974;:7:310-318.
5 +
1988 Joint National Committee.  The 1988 report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure . Arch Intern Med . 1988;;148:1023-1038.
6 +
 1989 Guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting . J Hypertens . 1989;;7:689-693.
7 +
Veterans Administration Cooperative Study Group on Antihypertensive Agents.  Effects of treatment on morbidity in hypertension, II: results in patients with diastolic blood pressure averaging 90 through 114 mm Hg . JAMA . 1970;;213:1143-1152.
8 +
Management Committee.  The Australian therapeutic trial in mild hypertension . Lancet . 1980;; 1:1261-1267.
9 +
Hypertension Detection and Follow-up Program Cooperative Group.  Five-year findings of the Hypertension Detection and Follow-up Program . JAMA . 1979;;242:2562-2571.
10 +
Amery A, Birkenhager 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.
11 +
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.
12 +
Goldstein G, Materson BJ, Cushman WC, et al.  Treatment of hypertension in the elderly, II: cognitive and behavioral function: results of a Department of Veterans Affairs Cooperative Study . Hypertension . 1990;;15:361-369.
13 +
Caird FI, Andrews GR, Kennedy RD.  Effect of posture on blood pressure in the elderly . Br Heart J . 1973;;35:527-530.
14 +
Goldstein IB, Shaprio D.  Cardiovascular response during postural change in the elderly . J Gerontol . 1990;;45:M20-M25.
15 +
Peitzman SJ, Berger SR.  Postprandial blood pressure decrease in well elderly persons . Arch Intern Med . 1989;;149:286-288.
16 +
Wilcox CS, Williams CM, Smith TB, Frederickson ED, Wingo C, Bucci CM.  Diagnostic uses of angiotensin-converting enzyme inhibitors in renovascular hypertension . Am J Hypertens . 1988;;1: 344S-349S.
17 +
Pearson AC, Gudipati CV, Labovitz AJ.  Systolic and diastolic flow abnormalities in elderly patients with hypertensive hypertrophic cardiomyopathy . J Am Coll Cardiol . 1988;;12:989-995.
18 +
Niarchos AP, Laragh JH.  Effects of diuretic therapy in low-, normal- and high-renin isolated systolic systemic hypertension . Am J Cardiol . 1984;;53:797-801.
19 +
West LJ, Maxwell DS, Noble EP, Solomon DH.  Alcoholism and aging . Ann Intern Med . 1984;;100:405-416.
20 +
Stuart EM, Deckro JP, Mamish ME, Friedman R, Benson H.  Non-pharmacologic treatment of the elderly hypertensive patient . Circulation . 1989;; 80( (suppl II) ):189.
21 +
Evans CE, Haynes RB, Goldsmith CH, Hewson SA.  Home blood pressure-measuring devices: a comparative study of accuracy . J Hypertens . 1989;;7:133-142.
22 +
Kaplan NM.  Critical comments on recent literature: age and the response to antihypertensive drugs . Am J Hypertens . 1989;;2:213-215.
23 +
Materson BJ, Cushman WC, Goldstein G, et al.  Treatment of hypertension in the elderly, I: blood pressure and clinical changes: results of a Department of Veterans Affairs Cooperative Study . Hypertension . 1990;;15:348-360.
24 +
Freis ED.  Age and antihypertensive drugs: (hydrochlorothiazide, bendroflumethiazide, nadolol and captopril) . Am J Cardiol . 1988;;61:117-121.
25 +
Wikstrand J, Westergren G, Berglund G, et al.  Antihypertensive treatment with metoprolol or hydrochlorothazide in patients aged 60 to 75 years . JAMA . 1986;;255:1304-1310.
26 +
Abernathy DR, Schwartz JB, Plachetka JR, Todd EL, Egan JM.  Comparison in young and elderly patients of pharmacodynamics and disposition of labetalol in systemic hypertension . Am J Cardiol . 1987;;60:697-702.
27 +
Ram CVS, Meese R, Kaplan NM, et al.  Antihypertensive therapy in the elderly: effects on blood pressure and cerebral blood flow . Am J Med . 1987;; 82( (suppl 1A) ):53-57.
28 +
Kaplan NM.  Calcium entry blockers in the treatment of hypertension: current status and future prospects . JAMA . 1989;;262:817-823.
29 +
Lichtlen PR, Hugenholtz PG, Rafflenbeul W, et al.  Retardation of angiographic progression of coronary artery disease by nifedipine: results of the International Nifedipine Trial on Antiatherosclerotic Therapy (INTACT) . Lancet . 1990;;335:1109-1113.
30 +
Yusuf S, Wittes J, Friedman L.  Overview of results of randomized clinical trials in heart disease, I: treatments following myocardial infarction . JAMA . 1988;;260:2088-2093.
31 +
Leonetti G.  The clinical performance of nicardipine in elderly hypertensive patients with concomitant diseases . Am Heart J . 1989;;117:266-269.
32 +
Mulinari R, Gavras I, Gavras H.  Efficacy and tolerability of enalapril monotherapy in mild to moderate hypertension in older patients compared to younger patients . Clin Ther . 1987;;9:678-689.

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