hypertension remains the first cause of cardiovascular risk and mortality worldwide , and , in people aged 65 or older , it has been duplicated in relation to four decades before . also population aged 80 or older is increasing ; the prevalence of hypertension in this group of people is above 60% and continues to grow . it is well known that hypertension   is per se associated to other risk factors such as overweight , obesity ( 46.8% ) , tobacco abuse , or hypercholesterolemia ( 45.4% ) . it is estimated that during the next years , 75% of the medical practice will be aimed at the geriatric age group . today , everybody wishes to reach elderly without ailments or clinical disorders that could seriously alter his quality of life . pharmacological therapeutics is especially aimed at studying that very common medical condition . during the last years , and before the final findings of the syst - eur were published , the general medical opinion considered not to decrease blood pressure values in order to avoid possible ischemic events and poor oxygenation of the trigger organs ( brain , myocardium , kidney , and visual organ ) . this strong belief within the medical community raised the question of whether or not aged people should receive pharmacological treatment similarly to other younger patients . this scientific question was raised at the beginning of the 90s about hypertensive people aged 6079 . until then , many clinicians thought that it was harmful to normalize blood pressure values of aged hypertensive people because of the hypothetical danger of ischemic events in the trigger organs and , then , the possibility to provoke serious cardiovascular complications . however , the results of the systolic hypertension in europe trial ( syst - eur ) , where our group has actively participated , clearly proved the benefits of hypertensive treatment versus placebo , in contrast to the nihilistic attitude to leave the disease to itself . the significant results of the syst - eur trial are based on the research and the ten - year followup of 4,227 patients from 23 european countries . these findings demonstrated ( 1 ) a reduction in cardiac mortality in the group of patients treated with antihypertensive agents ( nitrendipine , enalapril , and hydrochlorothiazide ) ; ( 2 ) a lower incidence of stroke , angina pectoris , and myocardial infarction in the group receiving active treatment ; ( 3 ) a   decrease in the incidence of dementia in this group . the potential reduction up to 50% of dementia episodes after treatment with antihypertensive agents was based on the use of   nitrendipine ( dihydropyridine calcium antagonist ) as the first drug with an important role in increasing the longevity of the elderly all over the world ; these findings also showed that the nonpharmacological intervention in this disease must not be neglected [ 3 , 4 ] . the results of the syst - eur trial suggest that combination therapy of nitrendipine plus enalapril could be interesting in a better prognosis of hypertensive patients . in conclusion , the benefits of the antihypertensive treatment in patients with hypertension aged 60 or older revealed a reduction in the cases of stroke and cardiovascular events , which has been confirmed by other studies and meta - analysis of the last years . also , it is well - known that life expectancy is rising around the world which is related to an increased risk of developing dementia ; this is becoming a major public health problem . the syst - eur study showed that randomized patients actively treated presented a lower incidence of dementia up to 50% ( from 7.7 to 3.8 cases every 1000 patients / yr ) ( 21 cases versus 11 cases ; p = 0.05 ) compared to the group treated with placebo . based on the placebo group , we can extrapolate that five - year treatment of 1,000 patients with isolated systolic hypertension could prevent 19 cases of dementia . therefore , the conclusive results of the syst - eur trial showed that physicians ( internists , cardiologists , primary care , endocrinologists , and others ) should treat hypertension drastically in aged patients and try to reach blood pressure values similar to those recommended in younger populations ( 130/80  mmhg ) ; these values should be lower when patients have also diabetes ( 125/75  mmhg ) . on the other hand , several observations suggested that calcium antagonists could have a specific neuroprotective effect . it is well known that both in vascular and mixed or degenerative dementias the values of the minimental state examination ( mmse ) are less decreased in patients treated with nimodipine than in those treated with placebo . brain aging is accompanied by alterations of intracellular calcium regulation , which leads to several cellular disorders , resulting in cellular death . disorders of calcium homeostasis are related to the brain 's aging process and the alzheimer 's disease . antihypertensive treatment and reduction in blood pressure levels decrease the risk of developing dementia in aged patients , which is an important finding for the public healthcare system ; calcium antagonists ( nitrendipine and nimodipine ) can have a specific neuroprotective effect . important advances have been achieved relating physiopathological , pathogenetic , and therapeutic mechanisms of arterial hypertension . however , few studies have been made until now including the treatment of hypertension in patients aged 80 or older . these significant results led the researchers to investigate whether the benefits of the syst - eur trial could be extrapolated to patients aged 80 or older . however , empiric therapy is not adequate to this important pathology . the question was the primum movens of the hyvet   study ( hypertension in the very elderly trial ) , which was designed to provide a clear , definitive , and scientific answer to the treatment of hypertension in individuals older than 80 years . the adequate control of these patients is greatly important for the general practitioners , internists , geriatrists , and other specialists , since hypertension together with other chronic conditions such as diabetes , hypercholesterolemia , and obesity are the main pathogenetic factors of cardiovascular disease , which is today the first cause of morbidity and mortality in the western countries . the risks and benefits of treating hypertensive patients were studied in the hyvet trial , in which our group participated actively . the pilot study was carried out in 1,283 patients and was supported by the british heart foundation . three different therapies were designed : ( 1 ) no treatment ; ( 2 ) low - dose diuretic - based regimen ( hydrochlorothiazide 12.525  mg daily ) ; ( 3 ) an angiotensin - converting enzyme inhibitor ( lisinopril 5  mg or enalapril 10  mg ) , following accurate inclusion and follow - up clinical criteria , and quality of results and procedures carried out according to protocol . the cases studied ( 1,283 patients ) were recruited from several european countries ( bulgaria , spain , romania , uk , poland , finland , lithuania , ireland , greece , and serbia ) [ 7 , 8 ] . this study demonstrated that treating 1,000 patients per year , 19 cases of stroke could be prevented ( nine of them nonfatal stroke ) . the good results of the study led to continue the investigation (  main hyvet trial  ) as international randomized double - blind trial . hyvet trial demonstrated the benefits of reducing blood pressure values in patients aged 80 or older and provided clear evidences about the need to treat hypertension in this growing population ; this has become very important in the clinical practice and therapeutic guides [ 9 , 10 ] . for many years , physicians have had the mistaken idea that hypertension was a result of ageing and that treatment was not necessary and no common criteria existed about the therapy on these cases ; some proposed no treatment , others suggested low - dose diuretics , and others recommended the use of other pharmacological groups ( angiotensin - converting enzymes inhibitors , calcium channel blocker , or angiotensin - ii receptor antagonists ) . it is well established that hypertension is frequently associated with several cardiovascular risk factors , such as obesity , hypercholesterolemia , diabetes , tobacco abuse , and others . this fact led to carry out new clinical trials including hypertensive population with other cardiovascular events , like convince ( controlled onset verapamil investigation of cardiovascular endpoints ) study ; this is a double - blind , randomized , multicentre , international trial which compared two initial treatments .    at the beginning , physicians could choice the treatment with hydrochlorothiazide ( hctz ) or atenolol , and the possibility to add controlled - onset extended - release   verapamil , if necessary . the protocol permitted an increase of the doses or the number of drugs until reaching values lower than 140/90  mmhg . a total of 16,602 patients were included in the study selected from 15 countries and 661 centres . the main risk factors of the participants were overweight ( bmi  28.5/m , 50.4% ) ; dyslipemia , 31.3% ; tobacco abuse 22.6% ; diabetes , 19.8% , and in a lower incidence others such as known vascular disease , left ventricular hypertrophy , previous myocardial infarction , transient cerebral ischaemia , and so forth . results showed a similar efficiency in the reduction of the cardiovascular disease with the calcium antagonist agents than with diuretics and beta blockers agents . there have been many therapeutic advances since the development of reserpine and phenobarbital as therapeutic agents , more than five decades ago . however , despite the excellent advances of the last years , hypertension continues to be the main factor of complication and cardiac death not only in the western population , mostly present as cerebral infarction and coronary heart disease . at the moment , the number of patients with controlled hypertension is under 25% all over the world and this could be due to the following reasons : ( 1 ) a difficult access to the healthcare system , ( 2 ) the lack of symptoms of hypertension , ( 3 ) the side effects of the antihypertensive agents , ( 4 ) the presence of other risk factors ( obesity , tobacco abuse , diabetes , hypercholesterolemia , etc . ) , ( 5 ) the concomitance of other associated noncardiovascular diseases ( pneumopathy , digestive disorders , and osteoarticular disorders ) , and ( 6 ) the difficulty in adjusting dosage . despite the therapeutic advances , uncontrolled hypertension is a growing problem in the developed countries and populations having easy access to the healthcare system . unfortunately , not all the hypertensive patients receive treatment when the values of the diastolic blood pressure are 9095  mmhg , specially , when only systolic blood pressure values between 140160  mmhg are considered . this is a very important problem , since in hypertensive people brain alterations secondary to vascular diseases lead to intellectual impairment and a worse quality of life of these patients [ 13 , 14 ] .   the action study   was carried out in 7,665 patients ( mean age 63.5 years ) randomly assigned to treatment with nifedipine gits ( gastrointestinal therapeutic system ) and 3,840 patients treated with placebo . the study demonstrated that after addition of nifedipine gits to the conventional treatment of angina pectoris , no effect was observed on major cardiovascular event - free survival , and it reduced the need to perform angiography and coronary interventions . table 1 shows some findings ( number of patients , age , and drugs used ) on clinical trials in aged hypertensive people . hypertension is a very important disorder in aged people and is associated with higher risk of cardiovascular morbidity and mortality . the fact of reducing blood pressure values decreases the risk for cardiac death as well as neurological , metabolic , and musculoskeletal system sequelae in aged people . therefore , the aim of the antihypertensive treatment must be to reduce cardiovascular risks and to maintain an adequate quality of life and good functional capacity in these patients .
background . 
 the incidence of hypertension in the western countries is continuously increasing in the elderly population and remains the leading cause of cardiovascular and morbidity . methods . 
 we analysed some significant clinical trials in order to present the relevant findings on those hypertensive population . 
 results . 
 several studies ( syst - eur , hyvet , convince , value , etc . ) have demonstrated the benefits of treatment ( nitrendipine , hydrochrotiazyde , perindopril , indapamide , verapamil , or valsartan ) in aged hypertensive patients not only concerning blood pressure values but also the other important risk factors . 
 conclusion . 
 hypertension is the most prevalent cardiovascular disorder in the western countries , and the relevance of receiving pharmacological treatment of hypertension in aged patients is crucial ; in addition , the results suggest that combination therapy 
 nitrendipine plus enalapril  could have more benefits than those observed with the use of nitrendipine alone .