Hypertension in Octogenarians – Treatment Strategies and Challenges

Abstract

The demographics of westernised countries are changing and older people now represent a larger and increasing proportion of the overall population. Since age is a potent risk factor for hypertension, this has resulted in many more octogenarians and older who require antihypertensive therapy. In this article we discuss the evidence base for drug treatment of octogenarians and older. We discuss the choice of drug therapies and outline some of the features that make treatment of such patients a challenge, in particular drug intolerance. We discuss the role of prescribing multiple low-dose therapies to increase the benefits while mitigating the adverse effects. We also discuss the thorny issues of polypharmacy and resistant hypertension and finally we discuss the role of ambulatory blood pressure monitoring as a tool for avoiding blood pressure misclassification in older subjects.