Importance of the field: Populations, the world over, age. Prevalence of hypertension increases with advancing age. Despite the advances over the past 30 years, there are still unresolved issues regarding antihypertensive therapy in the elderly.
Areas covered in this review: The present review discusses the available evidence supporting treatment of hypertension in the elderly.
What the reader will gain: In the 1980s and 1990s, a number of trials were performed and proved that active treatment of hypertension in individuals above the age of 60 - 65 years, compared with placebo or no treatment, reduces the risk of complications. In the 1990s, the same was proven in patients specifically affected with isolated systolic hypertension, the predominant form of hypertension in the elderly. The subsequent years witnessed the publication of trials that showed that most antihypertensive drugs are capable of substantially reducing risk. Finally, treatment of hypertension in the very elderly was proven to be beneficial.
Take home message: In spite of these advances, we still lack evidence in elderly patients with mild isolated systolic hypertension and are therefore in need of a properly designed, randomized, placebo-controlled trial.