Hypertension, both combined diastolic plus systolic and isolated systolic, is common in the elderly. Elderly hypertensive patients pose a number of diagnostic dilemmas, including pseudohypertension, postural and postprandial decreases in blood pressure, and the potential for renovascular hypertension. Data from large clinical trials have documented protection from cardiovascular complications by antihypertensive therapy for elderly people with combined systolic and diastolic hypertension. However, no data are available concerning the value of therapy for those with isolated systolic hypertension. Until such data become available from the Systolic Hypertension in the Elderly Program in 1991, cautious reduction of elevated systolic blood pressure levels is recommended. The fragile physiologic characteristics of the elderly demand caution and gentleness in the use of any therapy to lower blood pressure. Nondrug therapies are safe and may be effective. A variety of drugs are available and can be used to gradually reduce blood pressure to presumably safer levels.
Tjoa HI, Kaplan NM. Treatment of Hypertension in the Elderly. JAMA. 1990;264(8):1015–1018. doi:10.1001/jama.1990.03450080101040