Treatment of Hypertension in the Institutionalized Elderly

The goal of antihypertensive therapy in elderly institutionalized persons is to reduce the blood pressure to <140/90 mm Hg if possible. Elderly persons with diastolic hypertension should have their diastolic blood pressure lowered to 80–85 mm Hg. Elderly persons with stage 2 or 3 hypertension, stage 1 hypertension and target organ damage, evidence of clinical cardiovascular disease, or diabetes mellitus should be treated with antihypertensive drug therapy immediately in addition to lifestyle modification. The initial antihypertensive drug in elderly persons without associated medical conditions should be a diuretic or β-blocker because these drugs have been shown to decrease cardiovascular morbidity and mortality in controlled clinical trials. The initial antihypertensive drug in elderly persons should depend on the associated medical condition. If a second antihypertensive drug is indicated, a drug from another class should be administered. If a diuretic is not the initial drug, it is usually indicated as the second drug. If the antihypertensive response is inadequate after reaching the full dose of two classes of drugs, a third drug from another class should be added. Causes of secondary hypertension should be identified and treated.