POPULATION STUDIES: We reviewed population studies that relate mortality to blood pressure in the elderly. A positive relationship between blood pressure and mortality at the age of 60-69 years was weaker over the age of 75 and became a negative relationship over the age of 85, with hypertensive subjects living longer. This negative relationship probably reflects cardiac, respiratory and neoplastic disease in very elderly subjects with low blood pressure. Therefore, in very elderly hypertensive subjects we cannot conclude that a reduction in blood pressure will not be beneficial, for example in reducing stroke events.
Clinical trials: The results of clinical trials of antihypertensive treatment in the elderly provide inadequate evidence to assess the benefit of treating hypertensive subjects over the age of 80 years. A randomly allocated controlled trial is required in this age group.