Introduction
Until recent studies provided evidence-based data showing that hypertension (HTN) in the elderly can and should be treated, and that multiple agents are effective, the prevailing opinion was that “the treatment of hypertension is a difficult and almost hopeless task”. In fact, high blood pressure (BP) was believed to be a compensatory response to the narrowing of the coronary and cerebral vasculature that occurred with aging and as such should perhaps not even be “tampered” with. Projections for the growth of the older US population estimate there will be 82 million persons over 65 years (20% of the total population) and 19 million over 85 years (24% of the population over 65 years) by the year 2050. This growth in the older population is a result not only of an increase in the overall population size but also a decline in several of the major causes of mortality. However, despite aggressive efforts directed at reducing the burden of cardiovascular disease, the age-related increase in BP combined with the increase in the aging population, portends a public health “tsunami”. Control of HTN in the elderly is imperative, not only to reduce the risk of cardiovascular disease, stroke, and chronic kidney disease, but also the incidence of atrial fibrillation, congestive heart failure (CHF), and cognitive impairment. Multiple antihypertensive agents have proven useful in the elderly. It has been shown that a 10 mmHg reduction in systolic blood pressure (SBP) and a 5 mmHg reduction in diastolic blood pressure (DBP) significantly decrease the incidence of myocardial infarction, stroke, CHF, and overall mortality. Despite these findings, the rate of control of HTN is low, especially among the elderly, and reflects a need for more aggressive approaches, as well as improvements in the systems of care delivery. There is also a compelling need for research into the mechanisms of the age-related increase in BP and prevention of HTN in general.