Treating hypertension: the evidence from clinical trials - aim for treated diastolic pressure levels of 80-90 mm Hg.(Editorial)

Survey data show that most elderly people have hypertension.(1) Guidelines for treating hypertension in elderly people have evolved as data from observational studies and clinical trials have become available. As recently as 10 years ago it was unclear whether the benefits of drug treatment in elderly people outweighed the risks. Doctors were cautioned about the side effects of antihypertensive drugs and were advised to treat only those elderly patients with the highest blood pressures. Some expert panels recommended drug treatment for healthy 65-74 year old patients only when blood pressure levels reached 200/100 mm Hg or greater, and for healthy patients over 75 years only when diastolic blood pressure levels reached 120 mm Hg or greater.(2) The decision to treat elderly patients with smaller rises in blood pressure was left to the discretion of the individual doctor.(2)

Meta-analyses of the clinical trials of antihypertensive drug treatment in elderly people have been published recently,(3), (4), (5) and some of the uncertainties that faced expert panels 10 years ago have been resolved. By pooling the results of 13 clinical …