High Blood Pressure

The value of antihypertensive treatment is well established for patients age sixty years and over. The results are mixed for the oldest age group, eighty years and over. The European Working Party on High Blood Pressure in the Elderly Trial failed to demonstrate that antihypertensive treatment was significantly beneficial above the age of eighty (Amery et al.). In the STOP-Hypertension trial (Dahlöf et al.), this treatment resulted in a smaller reduction in the number of deaths from stroke, myocardial infarction, and other cardiovascular diseases in older than in younger patients. By contrast, in the SHEP trial the positive effect of active treatment, compared with placebo, on the relative risk of stroke increased with age, and reached its maximum in the group of patients age eighty years or older. In the Syst-Eur study, a significant reduction was found in morbidity, but not in mortality, in the oldest patients (Staessen et al., 1997). In a meta-analysis of data from 1,870 participants over age eighty, Gueyffier et al. suggested that treatment reduced the rates of stroke, major cardiovascular events, and heart failure by 30 percent. On the other hand, there was no reduction in mortality due to cardiovascular disease or in total mortality. The results of this meta-analysis, which were favorable for morbidity, argue against the existence of a threshold age beyond which hypertension should not be treated.