Hypertension in the Elderly

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry


In patients with sporadically elevated blood pressure or white coat hypertension, a 24-h ambulatory BP monitoring is useful. This chapter will provide an update in the clinical management of hypertension in the elderly. Most of the causes of secondary hypertension in the younger adult are relatively uncommon in the elderly with the exception of renal artery stenosis. Evaluation of target organ damage begins with a physical examination. Hypertensive retinopathy together with left ventricular hypertrophy and renal impairment are considered as an indicator of target organ damage There is positive evidence that treating hypertension in the elderly and very elderly provides clinical benefits. Several trials have indicated that lowering the systolic blood pressure (SBP) to less than 140 mmHg as recommended by the prevailing guidelines is not upheld by evidence in the elderly and does not benefit the elderly and the very elderly.


White coat hypertension Isolated systolic hypertension Sodium sensitivity Hypertensive retinopathy Renal artery stenosis 


  1. 1.
    Stokes GS. Management of hypertension in the elderly patient. Clin Interv Aging. 2009;4:379–389.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Aronow WS, Fleg JI, Pepine CJ, Artinian NT, Bakris G, Brown AS, et al. ACCF/AHA 2011. Expert Consensus Documented Hypertension in the Elderly. A report of the ACC Foundation Task Force on Clinical Expert Consensus Document, 2011.Google Scholar
  3. 3.
    Kaplan NM. Treatment of hypertension: Insights from the JNC-VI Report. Am Fam Physician 1998;58(6): retrieved 12 November 2007.
  4. 4.
    The Merck Manual of Geriatrics. Section 11. Cardiovascular disorders Chapter 85. Hypertension. retrieved on 12 November 2007.
  5. 5.
    Akpunon BE, Mulrow PJ, Hoffman EP. Secondary hypertension evaluation and treatment. Dis Mon. 1996;42(10):609–732.CrossRefGoogle Scholar
  6. 6.
    Onusko E. Diagnosis of secondary hypertension. Am Fam Physician. 2003;67(1):67–74.PubMedGoogle Scholar
  7. 7.
    Pimenta E, Oparil S. Management of hypertension in the elderly. Nat Rev Cardiol. 2012;9:286–296.CrossRefPubMedGoogle Scholar
  8. 8.
    The Sixth Report of the Joint National Committee in prevention, detection, evaluation and treatment of high blood pressure. Ann Int Med. 1997;157:2413–2146.Google Scholar
  9. 9.
    Wong TY, McIntsh R. Hypertensive retinopathy signs as risk indicators of cardiovascular morbidity and mortality. Br Med Bull. 2005;73–74(1):57–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Klag MJ, Whelton PK, Randall BC. Blood pressure and end – stage renal disease in men. NEJM. 1996;334:13–18.CrossRefPubMedGoogle Scholar
  11. 11.
    Susman Ed. Treatment of high blood pressure appears worthwhile in very elderly patients: Presented at ACC.
  12. 12.
    Allen M, Kelly K, Fleming I. Hypertension in elderly patients. Canad Fam Physician. 2013;59(1):19–21.Google Scholar
  13. 13.
    Australian National Blood Pressure Management Committee: The Australian Therapeutic Trial in Mild Hypertension. Lancet. !980; 1(8181):1261–7.Google Scholar
  14. 14.
    Medical Research Council Working Party. MRC Trial of treatment of mild hypertension: principal results. Br Med J (Clin Res Ed). 1985;291(6488):97–104.CrossRefGoogle Scholar
  15. 15.
    Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomized trial. Lancet. 1998;351:1755–62.CrossRefPubMedGoogle Scholar
  16. 16.
    Amery A, Birkenhager W, Brixko P, Bulpitt C, Clement D, Deruyttere M, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet.1985;1(8442):1349–54.CrossRefPubMedGoogle Scholar
  17. 17.
    Duprez D. Treatment of isolated hypertension in the elderly. Expert Rev Cardiovasc Ther .2012;10(11): 1367–73.CrossRefPubMedGoogle Scholar
  18. 18.
    James PA, Oparil S, Carter BL, Cushman WC, Dennion-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eight Joint National Committee (JNC 8). JAMA. 2013;
  19. 19.
    Angeli F, Reboldi G,Verdecchia P. “The lower the pressure the better” paradigm in the elderly: vanished by VALISH?. Hypertension. 2010;56(2):182–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Chobanian AV, Bakris JD, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure: the JNC report. JAMA. 2003;289:2560–7.CrossRefPubMedGoogle Scholar
  21. 21.
    Manica G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. 23rd European Meeting on Hypertension & Cardiovascular Protection.
  22. 22.
    Kahn NA, Hemmelgarn B, Herman RJ, Rabkin SW, McAlister FA, Bell CM, et al. Canadian Hypertension Education Program. The 2008 Canadian Hypertension Education Program recommendations for the management of hypertension: part 2-therapy, Can J Cardiol. 2008;24(6):465–75.CrossRefGoogle Scholar
  23. 23.
    Go AS, Bauman M, Sallyann M, Coleman King SM, Fonarow GC, Lawrence W, Williams KA. An effective approach to high blood pressure control. A science advisory from the American Heart Association, the American College of Cardiology and the Centers for Disease Control and Prevention. Hypertension. 2013. available at
  24. 24.
    Garrett AD. New AHA guidelines help manage hypertension in the elderly. Drug Topics, 2012. Retrieved on 9 January 2014.
  25. 25.
    Heart Foundation. Information from the Heart Foundation. Salt and Hypertension (Professional paper). retrieved 11 January 2014.
  26. 26.
    Mulrow CD, Cornell JA, Herrera CR, Kadri A, Farnett L, Aguilar C. Hypertension in the elderly: implications and generalizability of randomized trials. JAMA. 1994;272 (24):1932–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Moser M, Hebert PR. Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials. J Am Coll Cardiol 1996;27:1214–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Peart S, Brennan PJ, Broughton P, Dollery C, Hudson MF, Lever F, et al. Medical Research Council Working Party. MRC trial of hypertension in older adults: principal results. BMJ. 1992;304:405–12.CrossRefGoogle Scholar
  29. 29.
    Messerli FW, Grossman E, Goldbourt U. Are the beta-blockers efficacious as first line therapy for hypertension in the elderly? A systematic review JAMA. 1998;279: 1903–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Duggan K. Clinical complications of renin inhibitors. Aust Prescriber 2004:32:136–38.Google Scholar
  31. 31.
    Van Zeieten PA. Isolated systolic hypertension as a treatable risk factor. Neth Heart J. 2002;10(1):19–22.Google Scholar
  32. 32.
    Ramsay E,Wiiliam B, Johnston D, MacGregor GA, Poston L, Potter JF, et al. Guidelines for the management of hypertension. Report of the Third Working Party of the British Hypertension Society. BMJ. 1999;13:569–592.Google Scholar
  33. 33.
    William B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF, et al .British Hypertension Society guidelines for hypertension management. BMJ 2004;328(7440):634–640.CrossRefGoogle Scholar
  34. 34.
    Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, et al. Resistant hypertension: diagnosis, evaluation and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension. 2006;51:1403–1419.CrossRefGoogle Scholar
  35. 35.
    Krum H, Schlaich M,Whitboum R, Sobotka PA, Sadowski J, Bartus K, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof of principles cohort study. Lancet. 2009;373:21275–1281.Google Scholar
  36. 36.
    Symplicity HTN-2 Investigators. Esler MD, Krum H, Sobotka PA, Schlaich MP, Schmieder RE, Bohin M, et al. Renal sympathetic denervation in patients with treatment resistant hypertension (sympathetic HTN-2 trial): a randomised control trial. Lancet. 2010;376:1903–1909.CrossRefGoogle Scholar
  37. 37.
    Symplicity HTN-3 Investigators. Bhatt D, Kandzari DE, O’Neill WW, D’Agostino, Flack JM, Katzen BT, et al. A controlled trial of renal denervation for resistant hypertension. NEJM. 2014;370:1393–1401.CrossRefGoogle Scholar
  38. 38.
    Buford TW. Hypertension and aging. Ageig Res Rev. 2016;26:96–111.CrossRefGoogle Scholar
  39. 39.
    Stein JD, Brown GC, Brown MM, Sharma S, Hollands H, Stein HD. The quality of life of patients with hypertension. J Clin Hypertens. 2002;4:181–188.CrossRefGoogle Scholar
  40. 40.
    de Carvalho MV, Siqueira LB, Sousa ALL, Jardim PCBV. The impact of hypertension on quality of life. Arq Bras Cardiol. 2013;100(2).
  41. 41.
    Fogari & Zoppi A. Effect of antihypertensive agents on quality of life in the elderly. Drugs Aging. 2004;21(6);377–93.CrossRefPubMedGoogle Scholar
  42. 42.
    Wang R, Zhao Y, He X, Ma X, Yan X, Sun Y, et al. Impact of hypertension on health-related quality of life in a population – based study in Shanghai, China. Pub Health 2009;123:534–539.CrossRefGoogle Scholar
  43. 43.
    Lee MH, So ES. Impact of hypertension related comorbidity on health-related quality of life. Asia Pac J Public Health. 2012;2495):753–763.CrossRefGoogle Scholar
  44. 44.
    Gandhi SK, Kong SX. Quality-of-life measures in the evaluation of anti-hypertensive drug therapy: reliability, validity and quality of life domains. Clin Ther. 1996;18(6)1276–95.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

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