HYPERTENSION IN THE ELDERLY - 08/09/11

Doi : 10.1016/S0733-8651(05)70058-8

William C. Cushman, MD ^a, Henry R. Black, MD ^b

^a Departments of Preventive Medicine and Medicine, University of Tennessee College of Medicine, and the Veterans Affairs Medical Center, Memphis, Tennessee (WCC)

^b Departments of Preventive Medicine and Internal Medicine, Rush–Presbyterian–St. Lukes Medical Center, Rush University, Chicago, Illinois (HRB)

Résumé

Less than a decade ago, there was uncertainty as to whether hypertension, from elevated systolic (SBP) or diastolic blood pressure (DBP) levels, or both, should be treated in older persons. Various epidemiologic studies had consistently demonstrated that increasing levels of SBP correlate directly with the risk of developing cardiovascular events and mortality. In the elderly, SBP becomes a stronger predictor of risk than DBP or other standard risk factors besides age.^{21 Dyer A.R. An analysis of the relationship of systolic blood pressure, serum cholesterol, and smoking to 14-year mortality in the Chicago Peoples Gas Company Study: II. Coronary and cardiovascular-renal mortality in two competing risk models J Chron Dis 1975 ; 28 : 571-578 [cross-ref]

Cliquez ici pour aller à la section Références, 29 Kannel W.B., Dawber T.R., McGee D.L. Perspectives on systolic hypertension: The Framingham study Circulation 1980 ; 61 : 1179-1182

Cliquez ici pour aller à la section Références} Until 1991,^{45 SHEP Cooperative Research Group Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension: Final results of the Systolic Hypertension in the Elderly Program (SHEP) JAMA 1991 ; 265 : 3255-3264

Cliquez ici pour aller à la section Références} there were no prospective clinical trial data using SBP entry criteria to define whether treatment of hypertension based on SBP levels is beneficial and limited evidence on treating any elderly individuals with even diastolic hypertension.^{2 Amery A., Birkenhager W., Brixco P. , et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial Lancet 1985 ; 1 : 1349-1354 [cross-ref]

Cliquez ici pour aller à la section Références} The decade of the 1990s has clarified the perspective on treating hypertension in the elderly and provided a wealth of evidence to assist in the treatment of elevated blood pressure in older persons. Despite this wealth of information, important questions remain about treatment of hypertension in the elderly.