Guidelines for treatment of hypertension in the elderly--2002 revised version.

From the Research Group for “Long-Term Prognosis of Hypertension in the Elderly,” Comprehensive Research Projects on Aging and Health, the Ministry of Health, Labor and Welfare of Japan: *1Osaka University Graduate School of Medicine, *2Ehime University School of Medicine, *3Kanazawa Medical University, *4Dokkyo University School of Medicine, *5University of the Ryukyus School of Medicine, *6Sapporo Medical University, *7Jichi Medical School, *8Kyushu University, Graduate School of Medical Sciences, *9University of Tokyo Graduate School of Medicine, * 10International University of Health and Welfare, * 11Saitama Medical University, and * 12Tohoku University Graduate School of Pharmaceutical Science, Japan. Address for Reprints: Toshio Ogihara, M.D., Ph.D., Department of Geriatric Medicine, Osaka University Graduate School of Medicine, 2–2 Yamadaoka, Suita, Osaka 565–0871, Japan. E-mail: [email protected] Received and Accepted September 6, 2002. novo” types. The former generally develops in middle age as essential hypertension, and becomes systolic hypertension as the diastolic blood pressure is reduced due to the aging process, while the latter develops in old age due to reduced vascular compliance in the large arteries. In addition, there are some cases with secondary hypertension due to identifiable causes such as renovascular hypertension. In the elderly, it has been reported that systolic blood pressure is more strongly related with cardiovascular complications—especially stroke, ischemic heart disease, heart failure, end-stage renal disease, and all-cause mortality—than is diastolic blood pressure (3). Furthermore, it has been demonstrated that increased pulse pressure (the difference between systolic blood pressure and diastolic blood pressure) is correlated with an increased risk of such complications (4). The pathophysiology of hypertension in the elderly is characterized by increased total peripheral vascular resistance, decreased compliance of large and middle arteries, a tendency toward decrease in cardiac output and circulating blood volume, increased lability of blood pressure due to age-related decrease in baroreceptor function, decreased blood flow, and dysfunction of autoregulation in important target-organs such as the brain, heart, and kidney. Therefore, Introduction