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Guidelines for Treatment of Hypertension in the Elderly

Introduction

Hypertension is one of the most significant risk factors for cerebrovascular and heart diseases,which rank as the second and third most frequent causes of death in Japan, respectively.
 
The prevalence of hypertension rises as the population grows older, affecting approximately 60% of the Japanese aged 65 yr or older (1), and there are currently more patients receiving treatment for hypertension than for any other disease in Japan (2).
 
As the size of the elderly population in our country continues to increase rapidly, hypertension has become one of the most important diseases to control and treat, and developing an effective strategy for this disease has become a matter of great social immediacy. Hypertension in the elderly is composed mostly of essential hypertension, but the pathophysiology of essential hypertension in the elderly differs in many respects from that of essential hypertension in the young or middle-aged.
 
In particular, isolated systolic hypertension (systolic blood pressure 140 mmHg or greater, and diastolic blood pressure below 90 mmHg) increases in frequency with age. Isolated systolic hypertension is divided into two types, the so-called “burned-out” and “denovo” types. The former generally develops in middle age as essential hypertension, and becomes systolic hypertension as the diastolic blood pressure is reduced due to the aging process, while the latter develops in old age due to reduced vascular compliance in the large arteries.
 
In addition, there are some cases with secondary hypertension due to identifiable causes such as renovascular hypertension.

 


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