Perspective:

The following are 10 points to remember about the American College of Cardiology Foundation/American Heart Association 2011 Expert Consensus Document on Hypertension in the Elderly:

1. The US population is aging, and as hypertension affects most elderly people (≥65 years of age), these individuals are more likely to have organ damage or clinical cardiovascular disease.

2. Because dyslipidemia and hypertension are common among the elderly, it is reasonable to be aggressive with lipid lowering in elderly hypertensive patients.

3. Diagnosis of hypertension should be based on at least three different blood pressure (BP) measurements, taken on ≥2 separate office visits. At least two measurements should be obtained once the patient is seated comfortably for at least 5 minutes with the back supported, feet on the floor, arm supported in the horizontal position, and the BP cuff at heart level.

4. Lifestyle modification may be the only treatment necessary for milder forms of hypertension in the elderly. Smoking cessation, reduction in excess body weight and mental stress, modification of excessive sodium and alcohol intake, and increased physical activity may also reduce antihypertensive drug doses.

5. Drug treatment for elderly hypertensive patients has been generally recommended, but with a greater degree of caution due to alterations in drug distribution and disposal and changes in homeostatic cardiovascular control, as well as quality of life factors. The initial antihypertensive drug should be started at the lowest dose and gradually increased, depending on BP response, to the maximum tolerated dose.

6. Thiazide diuretics (hydrochlorothiazide [HCTZ], chlorthalidone, and bendrofluazide [bendrofluomethiazide]) are recommended for initiating therapy. In elderly patients who have coronary artery disease with hypertension and stable angina or prior myocardial infarction, the initial choice is a beta-blocker.

7. In elderly hypertensive patients with diabetes mellitus, angiotensin-receptor blockers are considered first line and as an alternative to angiotensin-converting enzyme inhibitors (ACEIs) in patients with hypertension and heart failure who cannot tolerate ACEIs.

8. Most elderly persons with hypertension will need ≥2 drugs. When BP is >20/10 mm Hg above goal, consideration should be given to starting with two drugs.

9. Achieved systolic BP values <140 mm Hg are appropriate goals for most patients ≤79 years of age; for those ≥80 years of age, 140-145 mm Hg, if tolerated, can be acceptable.

10. At present, prevention of hypertension in the elderly should be based primarily on a strategy of dietary salt restriction, weight control, and physical activity.