Abstract
In order to clarify the therapeutic policy for hypertension in the elderly, we mailed a questionnaire to 147 specialists in Japan and received 123 replies. The upper age limit for antihypertensive treatment was considered to be 80-85 years old by about 50% of the specialists, but the other 50% did not consider an upper age limit. The range of the systolic blood pressure (BP) for which drug treatment was indicated in those without cardiovascular complications was considered to be increased with age, being 160mmHg and higher in those aged 60-69, 160-170mmHg and higher in those aged 70-79, and 170-180mmHg and higher in those aged 80-89, while the level of diastolic BP requiring treatment was considered to be 90-95mmHg and higher in all age ranges. The goal of BP control was considered to be less than 150/90mmHg in those aged 60-69, and less than 160/90mmHg in those aged 70-79 by the majority of the specialists, and to be higher in those aged 80-90, i.e. less than 170-180/95-100mmHg by more than 20% of the specialists. As the initial selection of antihypertensive regimen, calcium antagonists followed by angiotensin I-converting enzyme inhibitors (ACEI) were selected by the majority, while diuretics, β-blockers and α1 blockers were chosen by the minority. The mean goals of BP control were considered to be slightly higher for elderly hypertensives with chronic cerebral infarction, with arteriosclerosis obliterance, or with renal insufficiency, being 154-159/89-90 and 160-164/90-91mmHg for those aged 70-79 and 80-89, respectively, but to be slightly lower for those with chronic stage cerebral hemorrhage, ischemic heart diseases, diabetes mellitus, and hyperlipidemia, being 152-153/88 and 158-159/89mmHg, for those aged 70-79 and 80-89, respectively. Calcium antagonists were most popular for initial treatment in those with any of these complications. ACEI was seldom used in cases with renal insufficiency. β-blockers were sometimes used in cases with ischemic heart diseases, but were seldom used in those with other cardiovascular complications. Diuretics and α1 blockers were not often used in these patients. The benefits of these various policies for treating hypertension of elderly patients should be evaluated in future long-term intervention trials in Japan.
