Update on Pathophysiology and Treatment of Hypertension in the Elderly

Hypertension is common in the elderly, and its prevalence increases with aging. The vascular system is a prototypical aging tissue, and arterial stiffness plays a major role in hypertension as the individual ages. Some unique aging changes in the nitric oxide and angiotensin II pathways are particularly important for vascular aging. Studies focusing on direct measures of vascular stiffness have increased understanding of the pathophysiology behind increased arterial stiffness. Goal blood pressure in the elderly is debated, but based on current outcome data, a goal blood pressure of 150/80-90 mm Hg is reasonable in at least the very elderly. This review discusses in detail the various landmark hypertension studies in the elderly. We recommend use of thiazide diuretics, long-acting calcium channel blockers, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers as either monotherapy or in combination, with beta-blockers reserved for patients with specific indications.