Prevalence of secondary hypertension and unusual aspects of the treatment of hypertension in elderly individuals

Although hypertension is very common in elderly subjects, there is little Published evidence on the effects of age on the Prevalence of ”secondary“ hypertension. Data derived from 2,880 untreated hypertensive subjects are Presented, showing that with increasing age from <18 to >70 years, the Prevalence of orthostatic hypertension falls from 17 to 4% while that of Primary aldosteronism, Cushing's syndrome and Pheochromocytoma changes very little and the Prevalence of hypertension due to hypothyroidism, renovascular stenosis and renal insufficiency increases Progressively, so that almost 10% of hypertensive Patients older than 60 years had renovascular hypertension or renal insufficiency. The SHEP study has shown that treatment of hypertension in the elderly significantly reduced cardiovascular but not total mortality. In secondary hypertension, specific, pathogenesis-related therapy is recommended and often effective. In elderly Patients with Primary hypertension, therapeutic decisions are influenced by the need to minimize side effects (such as orthostatic hypotension), the desirability of avoiding excessive reduction in (especially) diastolic Pressures, and the Possibility that in some situations treatment may actually reduce life expectancy.