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New thinking on hypertension in the elderly.

Most patients over the age of 60 with sitting casual systolic blood pressure averaging greater than 160 mm Hg and diastolic pressure greater than 90 mm Hg and those with isolated systolic hypertension with elevated mean arterial pressure should be treated to reduce their blood pressure to less than 160/90 mm Hg or the mean arterial pressure below 110 mm Hg without producing adverse effects. The treatment should be individualized when other patient characteristics indicate a preferred drug. When this is not the case, then a thiazide diuretic combined with a potassium-sparing diuretic, with the addition of a centrally acting alpha-agonist when needed to control blood pressure has been demonstrated to be effective. If the patient does not tolerate this, or if his blood pressure reduction is not satisfactory, then other drugs can be used effectively.