Drugs & Aging

, Volume 21, Issue 1, pp 1–6

Do We Need Drug Therapy to Manage Mild Hypertension in the Elderly?

Current Opinion


Mild hypertension (grade 1 or stage 1 hypertension) is defined as a systolic blood pressure of 140–159mm Hg or a diastolic pressure of 90–99mm Hg. According to current guidelines, patients with mild hypertension can be at low, medium, high or very high risk depending on the presence of other risk factors, target organ damage and associated cardiovascular or renal conditions. Guidelines recommend prompt initiation of antihypertensive treatment in patients at very high risk because of associated clinical conditions and this recommendation is strongly supported by the literature. Also patients at high risk must be treated without much delay, but it should be mentioned that the evidence is stronger for patients who are at high risk because of diabetes mellitus, than for patients at high risk because of left ventricular hypertrophy or the accumulation of ≥3 other risk factors.

Patients at low and medium risk should be followed up and given advice on nonpharmacological measures and treatment should only be initiated in cases of persistently elevated blood pressure. However, this advice is based on indirect evidence and is currently not supported by randomised controlled trials.

A survey on treatment of hypertension and implementation of World Health Organization/International Society of Hypertension (WHO/ISH) guidelines in primary care revealed that, respectively, only 20% and 33% of elderly men with mild hypertension at medium and high risk were treated with antihypertensive drugs and that this prevalence amounted to 67% in patients at very high risk; the prevalence was higher in patients with higher levels of blood pressure in each risk category.


  1. 1.
    McMahon S, Peto R, Cutler J, et al. Blood pressure, stroke and coronary heart disease. Lancet 1990; 335: 765–74CrossRefGoogle Scholar
  2. 2.
    Lewington S, Clarke R, Qizilbasch N, et al. Age specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data from one million adults in 61 prospective studies. Lancet 2002; 360: 1903–13PubMedCrossRefGoogle Scholar
  3. 3.
    Vasan RS, Larson MG, Leip EP, et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med 2001; 345: 1291–7PubMedCrossRefGoogle Scholar
  4. 4.
    The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–46Google Scholar
  5. 5.
    Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. JAMA 2003; 289: 2560–72PubMedCrossRefGoogle Scholar
  6. 6.
    Guidelines Subcommittee. World Health Organization-International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999; 17: 151–83Google Scholar
  7. 7.
    Guidelines Committee. European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011–53CrossRefGoogle Scholar
  8. 8.
    Thijs L, Fagard R, Lijnen P, et al. A meta-analysis of outcome trials in elderly hypertensives. J Hypertens 1992; 10: 1103–9PubMedCrossRefGoogle Scholar
  9. 9.
    Staessen JA, Gasowski J, Wang JG, et al. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet 2000; 355: 865–72PubMedCrossRefGoogle Scholar
  10. 10.
    Staessen JA, Fagard R, Thijs L, et al. Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet 1997; 350: 757–64PubMedCrossRefGoogle Scholar
  11. 11.
    Fagard RH, Staessen JA, Thijs L, et al. Response to antihypertensive therapy in older patients with sustained and nonsustained systolic hypertension. Circulation 2000; 102: 1139–44PubMedCrossRefGoogle Scholar
  12. 12.
    Fagard RH. Reversibility of left ventricular hypertrophy by antihypertensive drugs. Neth J Med 1995; 47: 173–9PubMedCrossRefGoogle Scholar
  13. 13.
    Van Hoof R. Left ventricular hypertrophy in elderly hypertensive patients: a report from the European Working Party on High Blood Pressure in the Elderly trial. Am J Med 1991; 90(3A Suppl.): 55S–9SPubMedCrossRefGoogle Scholar
  14. 14.
    Levy D, Salomon M, D’Agostino RB, et al. Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation 1994; 90: 1786–93PubMedCrossRefGoogle Scholar
  15. 15.
    Mathew J, Sleight P, Lonn E, et al. Reduction of cardiovascular risk by regression of electrocardiographic markers of left ventricular hypertrophy by the angiotensin-converting enzyme inhibitor ramipril. Circulation 2001; 104: 1615–21PubMedCrossRefGoogle Scholar
  16. 16.
    Parving HH, Lehnert H, Bröckner-Mortensen J, et al. The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 2001; 345: 870–8PubMedCrossRefGoogle Scholar
  17. 17.
    Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145–53CrossRefGoogle Scholar
  18. 18.
    PROGRESS Collaborative Group. Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6,105 individuals with previous stroke or transient ischemic attack. Lancet 2001; 358: 1033–41CrossRefGoogle Scholar
  19. 19.
    Flather MD, Yusuf S, Køber L, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left ventricular dysfunction: a systemic overview of data from individual patients. Lancet 2000; 355: 1575–81PubMedCrossRefGoogle Scholar
  20. 20.
    Bristow MR. Beta-adrenergic receptor blockade in chronic heart failure. Circulation 2000; 101: 558–69PubMedCrossRefGoogle Scholar
  21. 21.
    Fagard RH, Van Den Enden M, Leeman M, et al. Survey on treatment of hypertension and implementation of WHO/ISH risk stratification in primary care in Belgium. J Hypertens 2002; 20: 1297–302PubMedCrossRefGoogle Scholar
  22. 22.
    Fagard RH, Van den Enden M. Treatment and blood pressure control in isolated systolic hypertension vs diastolic hypertension in primary care. J Hum Hypertens 2003; 17: 681–7PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  1. 1.Hypertension and Cardiovascular Rehabilitation Unit, Department of Molecular and Cardiovascular Research, Faculty of MedicineUniversity of Leuven K.U. LeuvenLeuvenBelgium
  2. 2.U.Z. Gasthuisberg - HypertensieLeuvenBelgium

Personalised recommendations