Goals of Hypertension Treatment

• Most people have a blood pressure goal of less than 140/90 mmHg. In patients with diabetes or other chronic diseases, a lower goal of 130/80 mmHg may be appropriate.
  
  

First-line Treatment of Hypertension

• Thiazide diuretics are considered first-line therapy for treatment of high blood pressure in the elderly due to their safety and effectiveness. Examples of thiazide diuretics include indapamide, chlorthalidone, and hydrochlorothiazide.
  
  

Alternative Treatment Options

• Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers and calcium channel blockers may be used to lower blood pressure in the elderly. Lower-than-usual starting doses should be used and the dose should be increased slowly to achieve the appropriate blood pressure goal.
  
  

Drugs to Avoid

• Alpha-blockers should generally not be used in the elderly due to the significant risk of extremely low blood pressure.
  
  

Safety Concerns

• All blood pressure drugs can be problematic in elderly patients since the elderly are more likely to experience low blood pressure as a side effect, leading to dizziness and falls. Also, elderly people often have multiple chronic conditions and medications, resulting in an increased risk of drug-drug and drug-food interactions.
  
  

Warning

• All patients should discuss the risks and benefits of all available treatment options with their health care provider to decide which drug is right for them.