Treatment of hypertension in the elderly

Dr Giuseppe Mancia is an emeritus professor of medicine at the University of Milano-Bicocca (Italy) and past president of the International Society of Hypertension and the European Society of Hypertension.

What is the current approach to the treatment of hypertension in elderly patients?

Giuseppe Mancia, MD, PhD: Not really different from that in the young patients. There have been suggestions in the past that one might use some drugs in younger patients and some other drugs in older patients, but meta-analyses of major trials do not show any significant differences in the degree of protection according to age.

So the same drugs, but different targets, because in the elderly we should go below 140 mm Hg rather than 130 mm Hg, and of course some cautionary elements. For example, in the elderly, and in the very elderly in particular (those over 80 years), we should not start with 2 drugs but with 1 drug, because of the greater risk of having an excessive blood pressure reduction, injurious falls, fractures, and things like this. Then, of course, doses should be lower at the start and increased more smoothly. These are very obvious elements of caution in the elderly, but the type of drugs to be used are more or less the same.