Should Hypertension in the Elderly be Treated?

Abstract

Any discussion of arterial hypertension in the elderly must essentially turn on the vexed question of the indications and limitations imposed on its treatment. We can perhaps oversimplify the matter by saying that there are two approaches towards antihypertensive management in the aged: intervention, and abstention wherever possible. Let me say straightaway that I am to be found in the second camp for both clinical and physiopathological reasons. From the clinical standpoint, long experience with patients of this type has convinced me that treatment — by which I mean management imbued with a certain degree of “aggressiveness” — is often accompanied by side-effects that greatly cloud the quality of life, while its influence on the quantity of life is, to say the least, debatable. In physiopathological terms, too, there do not seem to be sure premisses for a rationally effective and useful intervention. The question may thus seem somewhat categorical, and certainly in opposition to the normal run of things (at any rate to non-geriatricians). I shall therefore try to explain the steps that led me to this conclusion. I must say that I came to the approach of abstention wherever possible through a long evolution (or involution, according to one’s point of view) starting from the taken-for-granted equation: “hypertension increases the vascular risk, therefore correction of hypertension decreases such risk.”