Ipertensione e anziani : nuove strategie terapeutiche

High blood pressure is one of the most important cardiovascular risk factors and its incidence is continuously increasing: in 2025 1/3 of the adult world's population will suffer from it. Moreover, the therapy for elderly patients suffering from high-blood pressure is still growing in importance due to the continuous increase in the average age of the world's population. With aging, the cardiovascular system suffers from neuro-hormonal and hemodynamic modifications which determine the onset of isolated systolic hypertension, which is characteristic of the elderly. This pathology is linked to a higher cardiovascular risk compared to only diastolic pressure increase. Moreover, in elderly people systolic blood pressure values must be lower than 150 mmHg, but it is also important to maintain diastolic pressure not under 70 mmHg, to avoid phenomena of cerebral and coronary hypo-perfusion (J curve). The benefits of an effective anti-hypertensive therapy are achieved thanks to both blood pressure lowering "per se" and to the decrease in cardiovascular mortality and morbility. Blood pressure control in the elderly is a hard challenge because of the low compliance to the therapy, for the importance of the comorbidity and the supplementary risk factors. Taking everything said above into account, ESH/ESC 2007 guidelines recommend for elderly patients suffering from high-blood pressure to use as first line calcium-antagonists and thiazides diuretics, and as second line ACE-inhibitors, ARB and beta-blockers. Since in several patients combinations of two or more drugs are necessary to obtain pressure control, fixed combinations could simplify treatment and enhance compliance.