Elderly Hypertensive Patients: Guideline Recommendations vs Reality

Professor Neil R. Poulter Chair in Preventive Cardiovascular Medicine, Imperial College London. For most hypertensives, systolic blood pressure (SBP) is a greater predictor of major adverse cardiovascular events (MACE) than diastolic blood pressure (DBP) and especially in older patients. Isolated systolic hypertension (ISH) is the most common hemodynamic form of hypertension in the elderly. So, how do we define elderly? Over 55 years, > 60, >70, > 75 or >80? Should we consider frailty-based decisions? Guidelines recommend tighter BP targets and BP control within 3 months for elderly hypertensive patients. With monotherapy usually being inadequate therapy for most hypertensive patients, which 2 drug combination are the most effective agents at lowering SBP & blood pressure variability (BPV)- especially in isolated systolic hypertension (ISH) therefore can be considered for the elderly hypertensive patient? Review a clinical case and randomized control trial evidence to discover the answer to these questions.