The treatment of hypertension in very old persons: Benefits and limitations

The treatment of arterial hypertension is a key strategy for the prevention of stroke and heart failure even in very old hypertensive patients. However, it is a challenging public health task given the sheer number of patients, the complexity, duration and cost of treatment and safety issues. To avoid overtreatment, it is important to confirm the diagnosis with 24-hour ambulatory blood pressure (BP) monitoring or BP monitoring at home. A systolic BP of 150 mmHg (135-140 mmHg with out-of-office measures) is an acceptable cut-off value both for the diagnosis of hypertension and as a target for treatment in most patients more than 80 years old. Avoiding “going too low” not only at the initiation of therapy, but also during follow-up, is important for treatment safety. Treatment should be initiated and followed up in a shared decision-making process, taking the patients' preferences into account. These strategies will help to ensure treatment adequacy and safety. Conversely, the fear of drug-induced orthostatic hypotension should in itself only rarely be a reason not to treat.