Management of hypertension in the elderly patient

Figures & data

Table 1 Age-associated trends in clinical hypertension

Sodium sensitivity increases with age, as does the hypotensive response to diuretics Isolated systolic hypertension becomes more frequent than systolic–diastolic hypertension Arterial stiffness increases There is a greater incidence of endothelial dysfunction The frequency of ‘white coat effect’ increases

Table 2 Initial investigations recommended for newly-presenting elderly hypertensive patients

Plasma electrolyte concentrations

Plasma creatinine concentration

Plasma uric acid concentration

Plasma renin activity

Plasma aldosterone concentration

Plasma lipids

Urine microscopy

24-hour urinary aldosterone excretion*

24-hour urinary catecholamine excretion*

Renal ultrasound

Computed tomography scan of renal arteries*

Overnight oximetry*

Echocardiography

* Note: These tests are not needed in all patients.

Table 3 Management problems in elderly hypertensive patients

Problem	Steps indicated
‘White coat effect’	Automated blood pressure recording
Hypertension–hypotension syndrome	Measure postural changes in blood pressure
Inadequate response to therapy	Check treatment compliance
	Perform pulse wave analysis
	Trial of long-acting nitrate
	Trial of spironolactone