Concept of Antihypertensive Treatment in the Elderly
The level of blood pressure to be treated in the elderly depends on the daily activity and target organ complications of each individual subject. Generally speaking, when systolic blood pressure exceeds 170 mmHg or diastolic blood pressure exceeds 90 mmHg consistently for a certain period of time, I would recommend treating the patient. This dividing line is based on a prospective study we performed in elderly hypertensives. The relationship between the pretreatment blood pressure level and cardiovascular end points was analyzed in the placebo group of the study: cardiovascular end points were significantly higher when systolic blood pressure exceeded 170 mmHg or when diastolic blood pressure exceeded 90 mmHg. The mean age of the patients in this study was 76.5 years. Therefore, we treated patients 60–69 years old when their blood pressure exceeded 160/90, because they are still active in social life. The average life expectancy in Japan is about 75 years for males and 80 years for females. In patients aged 70–79, I start treatment when blood pressure exceeds 170/90. Over 80 years of age, I usually do not start antihypertensive treatment unless there are dangerous complications or symptoms related to hypertension, but I continue to treat hypertensive patients aged 80 years or more if they are already under treatment.
KeywordsSystolic Blood Pressure Diastolic Blood Pressure Calcium Antagonist Antihypertensive Treatment Blood Pressure Level
Unable to display preview. Download preview PDF.