Treatment of the older adult

Hypertension, especially isolated systolic hypertension, is common in older people. White coat hypertension is also very common in older individuals making ambulatory blood pressure monitoring (ABPM) essential to confirm the diagnosis of hypertension. Hypertension is a major risk factor for cerebrovascular accidents, coronary artery disease, heart failure, retinopathy, chronic renal disease, and cognitive impairment. The benefits of treating hypertension including isolated systolic hypertension in the elderly has been demonstrated conclusively. Overtreatment can be harmful and caution is advocated in the very old. Non-pharmacological approaches are an integral part of management. Management can be challenging because of side effects especially postural hypotension, polypharmacy, frailty, and coexisting multiple chronic conditions.