Recently, 2 subanalyses of clinical trials suggested that there may be harm from the overtreatment of hypertension in the elderly.1,2 The first, a meta-analysis of clinical trials of antihypertensive drug therapy, concluded that antihypertensive therapy might increase the total mortality of people above the age of 80 years.1 The second, a subanalysis of the Systolic Hypertension in the Elderly Program (SHEP),2 showed that a decrease in diastolic blood pressure (BP) increased the risk of stroke, coronary heart disease, and cardiovascular disease in the active treatment group.2 These articles suggest that antihypertensive therapy in the elderly population should be highly individualized. As the threshold of BP needed to maintain blood flow shifts to a higher level in elderly subjects with hypertension, antihypertensive therapy might trigger ischemic episodes. Ambulatory BP monitoring3 has the potential to identify elderly patients with hypertension who are at high risk of developing ischemic target organ damage.
Kario K, Pickering TG. Does Extreme Dipping of Nocturnal Blood Pressure in Elderly Hypertensive Patients Confer High Risk of Developing Ischemic Target Organ Damage From Antihypertensive Therapy?. Arch Intern Med. 2000;160(9):1378. doi: