Therapeutic expectations in the middle-aged or elderly hypertensive subject

The goals of antihypertensive therapy are the same in all age groups. The challenge is greater in the older population because of the large numbers of people at risk. The benefits of identifying and successfully treating hypertension in this group are, from an epidemiologic standpoint, also greater because its influence as a risk factor for cardiovascular morbidity and mortality is strongly correlated with age. Effective therapy may not only decrease mortality but would also be expected to improve resting and exercise ventricular function in this age group. Nondrug therapy should be attempted. The choice of which agent to use is influenced by an age-related decrease in sympathetic responsiveness and an increase in peripheral vascular resistance. Although the side effect profile is somewhat altered and the risk of therapy may be higher with increasing age, the risk of elevated blood pressure far outweighs the risk of toxicity of well-supervised antihypertensive therapy.