Hypertension in older adults

• Hypertension affects > 60% of individuals > 60 years of age.

• Most older adults have isolated systolic hypertension.

In older adults, isolated systolic hypertension is common because of age-related stiffening of the arteries.

• Diagnosis of hypertension in older adults is similar to younger adults.

• Record orthostatic vital signs upon diagnosis.

• Patients with acute severe hypertension require treatment for hypertensive crises.

• Thresholds for initiating routine treatment in older adults are controversial and vary by guideline between SBP ≥ 130 mm Hg and BP ≥ 150/90 mm Hg.

• Choice of antihypertensive therapy

  • First-line antihypertensive medications are the same as in younger adults.

  • If possible, avoid:

    • Beta-blockers: increased CVD risk in adults > 60 years of age

    • Alpha-blockers and loop diuretics: risk of orthostatic hypotension and falls

• Regularly reassess functional status, renal function, electrolyte levels, and orthostatic vital signs.