Arterial hypertension in the elderly

Zygmunt Chodorowski

Summary
Arterial hypertension, and particularly its isolated systolic type, is a common disease in the the elderly and accounts for 60-70% of the old age population. The present paper includes the latest recommedations of the 7th report of the JNC, the European Society of Hypertension, and the European Society of Cardiology, which highlight the need for combination therapy with two or more antihypertensive drugs.
The choice of single-drug or combination therapy should be individually adjusted and should consider risk factors of atherosclerosis, concomitant diseases, response to treatment and the quality of life.
The most effective treatment of elderly hypertensive patients appears to be the therapy with thiazide diuretics, although any pharmaceutical agents of four main antihypertensive drug groups used in many studies have shown equal benefits. At present, only alpha-adrenolytics seem to have lost their popularity, and are not recommended in single-drug but only in combination therapy.
Angiotensin converting enzyme inhibitors are particularly indicated in left ventricular systolic dysfunction, previous myocardial infarction, diabetic nephropathy, and glomerular nephropathies.
To ensure prevention and nephroprotection in patients with type 2 diabetes and arterial hypertension, angiotensin receptor antagonists are mainly recommended.

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