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Hypertension is the most common psychosomatic disorder affecting 972 million people worldwide. The present clinical study deals with the effect of Makandi (Coleus forskohlii (Willd.) Briq.) Ghana vati and tablets of its powder in hypertension found in the geriatric age group (50-80 years). A total of 49 hypertensive patients fulfilling the diagnostic criteria were registered in two groups-Group I (Ghana vati) and Group II (Churna tablet). Out of 27 enrolled patients of group I, 21 patients completed the treatment. In Group II, out of 22 registered patients, a total of 20 patients completed the treatment. The effect of the therapy was assessed on the basis of changes in the systolic and diastolic blood pressures, in both sitting and supine positions; with Manasa Bhava Pariksha, Manasa Vibhrama Pariksha, symptomatology, geriatric signs and symptoms, and a brief psychiatric rating scale. Analysis of the results showed that the treatment in both the groups had been found to be good. It can be stated that Makandi, either in Ghana vati form or in churna tablet form, is an effective remedy for the treatment of hypertension. On analyzing the overall effect, 76.19% patients in Group I and 75.00% patients in Group II were mildly improved. Comparatively the overall treatment with group I was found to be better.

This clinical trial was conducted to evaluate the efficacy of Shirodhara and that of Sarpagandha Vati in essential hypertension. A total 47 patients were selected for study, out of which 40 patients (20 in each group) completed the course of treatment. Study subjects were randomly allotted into two groups, with one group being treated with Shirodhara and the other with Sarpagandha Vati. Specialized Ayurvedic rating scales like Manasa Pariksha Bhava as well as the Hamilton Anxiety Rating Scale were adopted to assess the effect of therapy. The effects of treatment on the chief complaints and the associated complaints were also evaluated. The results in the Shirodhara group were better than that in the Sarpagandha group. Although both Sarpagandha Vati and Shirodhara helped in reducing systolic and diastolic pressures, the effect of Shirodhara was more marked.

Diabetes mellitus is a common chronic metabolic disorder prevalent all over the world. Virechana is the Shodhana procedure that is specific for the elimination of vitiated Pitta and Kapha doshas. Thus, in the present study, the Virechana process has been selected prior to the administration of Shamana drug. Nyagrodhadi churna is mentioned in Chakradatta, which is modified into Ghana form for easy administration and dose maintenance. The present study was conducted in two groups: Group A, Nyogrodhadi Ghana vati (Shamana therapy) and Group B, Virechana and Nyogrodhadi Ghana vati (combined therapy). A total of 42 patients were registered for the present study, in which 34 patients completed the and eight patients were dropouts. After evaluating the total effect of the therapies, it was observed that the Virechana and Nyagrodhadi Ghanavati (combined therapy) provided better relief in the patients of Madhumeha in comparison with Nyagrodhadi Ghanavati (Shamana therapy) alone.

The present study was aimed to assess the clinical effectiveness of Rasona Rasnadi Ghanavati and Simhanada Guggulu along with Rasona Rasnadi Lepa in Amavata, and to compare the effect of these two therapies in the treatment. Total 101 patients of Amavata were registered for the present study and were randomly divided into two groups. In group A- Rasona Rasnadi Ghanavati 2 Vati thrice/day was given for 3 months, while in group B- Simhanada Guggulu 2 Vati thrice a day for 3 months was adminstered. Along with this, Rasona Rasnadi Lepa was applied locally over affected joints twice daily in both groups. The effects of therapy in both groups were assessed by a specially prepared proforma. The results of the study showed that both the groups showed significant relief in symptoms; however, compared to Simhanada Guggulu, Rasona Rasnadi Ghanavati showed better result in the management of Amavata. Simhanada Guggulu or Rasona Rasnadi Ghanavati along with Rasona Rasnadi Lepa can be used as an effective ayurvedic intervention in the treatment for rheumatoid arthritis.

Background

Low levels of detection, treatment and control of hypertension have repeatedly been reported from sub Saharan Africa, potentially increasing the likelihood of target organ damage.

Methods

A cross-sectional study was conducted on 1015 urban civil servants aged≥25 years from seven central government ministries in Accra, Ghana. Participants diagnosed to have hypertension were examined for target organ involvement. Hypertensive target organ damage was defined as the detection of any of the following: left ventricular hypertrophy diagnosed by electrocardiogram, reduction in glomerular filtration rate, the presence of hypertensive retinopathy or a history of a stroke.

Results

Of the 219 hypertensive participants examined, 104 (47.5%) had evidence of target organ damage. The presence of target organ damage was associated with higher systolic and diastolic blood pressure levels. The odds of developing hypertensive target organ damage was five to six times higher in participants with blood pressure (BP)≥180/110 mmHg compared to those with BP<140/90 mmHg, and there was a trend to higher odds of target organ damage with increasing BP (p = 0.001). Women had about lower odds of developing target organ damage compared to men.

Conclusions

The high prevalence of target organ damage in this working population associated with increasing blood pressure, emphasises the need for hypertension control programs aimed at improving the detection of hypertension, and importantly addressing the issues inhibiting the effective treatment and control of people with hypertension in the population.

To examine the effect of “DeepaniyaVati”, a herbal formulation in the management of hyperlipidemia, a randomized group pre-test post-test study trial was carried out on fifty male (30 to 70 yrs) hyperlipidemic volunteers who were asked to follow their normal routine diet and activity pattern throughout the investigation period. The formulation, prepared by mixing nine plant products in equal proportion, when given in a daily dose of 2g, twice a day for a period of one month, brought about an observable improvement in all the lipid parameters by significantly reducing total cholesterol (10%), low density lipoprotein cholesterol (12.76%), very low density lipoprotein cholesterol (27.4%), triglycerides (34.7%) and bringing these values much nearer to the normal levels. In control group, no such effect was noticed. A concomitant significant increase in the HDL-C levels suggests the possible utility of “Deepaniya Vati” in the management of hyperlipidemia and the need for further detailed study.

Future hypertension research will include not only fundamental pathophysiology and new methods of drug therapy but also research into which groups require special treatment. Hypertension is most common in the elderly, but after age 70 is only weakly associated with cardiovascular morbidity and mortality, mainly in females, and more related to systolic hypertension than diastolic. Hypotensive therapy has not yet proven to be of benefit in this age group. Trials of therapy, perhaps especially in systolic hypertension, in women and in previous stroke victims could well be carried out cooperatively by family physicians. The effectiveness of salt reduction and weight reduction in lowering blood pressure is controversial, but could be tested in cooperative trials, especially for borderline hypertensives and possibly for children of hypertensive parents.

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In type 2 diabetes, insulin resistance is the main problem that is associated with a cluster of conditions such as obesity and hyperlipidemia. The present study was designed with the objective to evaluate the role of Mehamudgara vati (MMV), which was expected to work at the level of Medodhatwagni due to its Medohara properties, to have an effective control on type 2 diabetes. To fulfill the objective, known patients of type 2 diabetes attending the OPD and IPD of Kayachikitsa Department, IPGT and RA, were selected and were divided in two groups. In Group A, MMV was given 3 tab. thrice a day with lukewarm water for 3 months and in Group B, the patients who were already taking modern antidiabetic treatment, although their blood sugar level was not well under control, were additionally given MMV in the same manner. The formulation has shown a highly significant decrease in the fasting and post-prandial blood sugar level. The formulation has also shown a synergistic action when combined with the modern antidiabetic drugs due to its known hypolipidemic, hypocholesterolemic, hepatoprotective, antihyperglycemic, antistress, antioxidant and immunomodulatory activities.

Systemic arterial hypertension in children has traditionally been thought to be secondary in origin. Increased incidence of risk factors like obesity, sedentary life-styles, and faulty dietary habits has led to increased prevalence of the primary arterial hypertension (PAH), particularly in adolescent age children. PAH has become a global epidemic worldwide imposing huge economic constraint on health care. Sudden acute increase in systolic and diastolic blood pressure can lead to hypertensive crisis. While it generally pertains to secondary hypertension, occurrence of hypertensive crisis in PAH is however rare in children. Hypertensive crisis has been further subclassified depending on presence or absence of end-organ damage into hypertensive emergency or urgency. Both hypertensive emergencies and urgencies are known to cause significant morbidity and mortality. Increasing awareness among the physicians, targeted at investigation of the pathophysiology of hypertension and its complications, better screening methods, generation, and implementation of novel treatment modalities will impact overall outcomes. In this paper, we discuss the etiology, pathogenesis, and management of hypertensive crisis in children. An extensive database search using keywords was done to obtain the information.

OBJECTIVE--To assess the clinical benefits of treating hypertension in elderly patients and to derive practical guidelines regarding indications, goals, and forms of treatment. DESIGN--Review of six published randomised trials. RESULTS--Active treatment of hypertension in elderly patients was associated with significant improvements in several indices of cardiovascular morbidity and mortality, particularly the incidence of fatal and non-fatal strokes. On the basis of the trial data, combined systolic and diastolic hypertension was defined as a sustained systolic pressure greater than 160 mmHg and diastolic pressure greater than 90 mmHg. There is convincing evidence that efforts should be made to reduce both systolic and diastolic pressures to below these levels in patients up to the age of 80 years. Isolated systolic hypertension was defined as a systolic pressure greater than 160 mmHg in the presence of a diastolic pressure less than 90 mmHg. Two trials reported benefit from the treatment of isolated systolic hypertension in patients up to the age of 80, and further trials are underway to support or refute this recommendation. Diuretics have an established role in the management of hypertension in elderly patients; beta adrenoceptor antagonists have given variable results, and the benefits are less impressive than with diuretic based regimens. Newer agents show promise in the treatment of elderly patients, particularly in the presence of coexisting disease, but their effects on morbidity and mortality have not been evaluated in large randomised trials. CONCLUSIONS--Diuretics rather than beta blockers are the treatment of choice for patients with uncomplicated hypertension, but combinations of drugs may be required in as many as 50% of patients.

The Canadian Hypertension Education Program (CHEP) was established in 1999 as a response to the result of a national survey that showed that a high percentage of Canadians were unaware of having hypertension with only 13% of those treated for hypertension having their blood pressure controlled. The CHEP formulates yearly recommendations based on published evidence. A repeat survey in 2006 showed that the percentage of treated hypertensive patients with the blood pressure controlled had risen to 65.7%. Over the first decade of the existence of the CHEP, the number of prescriptions for antihypertensive medications had increased by 84.4% associated with a significant greater decline in the yearly mortality from stroke, heart failure and myocardial infarction and a significant decrease in the hospitalization for stroke and heart failure. Therefore, the introduction of the CHEP and the yearly issue of updated recommendations resulted in a significant increase in the awareness, diagnosis and treatment of hypertension and in a significant reduction in stroke and cardiovascular morbidity and mortality. The CHEP model could serve as a template for its adoption to other regions or countries.

Diabetic nephropathy is a specific form of renal disease. It is a major cause of renal insufficiency and ultimately of death. The present study has been carried out to prove the efficacy of Ayurvedic drugs in the management of diabetic nephropathy, which can be helpful in reducing the need of dialysis and avoiding or delaying renal transplantation. A total of 130 patients of this disease were treated in IPD (Group A) and OPD (Group B). Ayurvedic formulations including Gokshuradi Guggulu, Bhumyamalaki, Vasa and Shilajatvadi Vati were given to all the patients for 2 months. Group A patients were given special planned food. Results were analyzed statistically using “t” test. In group A patients, highly significant reduction was found in the values of serum creatinine, blood urea and urinary excretion of albumin. Marked improvement was found in the patients’ general physical well-being, together with reduction in symptoms, in group A patients. This shows the importance of Pathyapathya in Ayurvedic management of the disease. This management may bring some new hope to the patients of diabetic nephropathy, which usually terminates to chronic renal failure and ultimately to death. Further studies are being carried out in this regard.

Data were collected on a cohort of 435 black medical students whose attendance at Meharry Medical College fell within the period 1958 to 1965, providing baseline measurements on multiple possible hypertension precursors. Relevant family history, sociodemographic, and clinical characteristics were obtained. Fifty percent of the students had at least one of the following possible precursors of hypertension: systolic blood pressure >120 mmHg; diastolic blood pressure >80 mmHg; pulse >80 beats/min; and relative body weight >120 percent of ideal body weight. Contrary to expectations, students from professional families were more likely to have higher systolic blood pressures. Students whose parents had a positive history of hypertension or stroke were likely to have higher diastolic blood pressures. Of the 24 students found to be hypertensive on survey (1981), 73 percent had a positive parental history of hypertension or stroke compared with only 40 percent of a control group matched by age and sex. A 17-year follow-up is currently underway to develop a risk profile for hypertension among black professionals.

Childhood period is considered as the period of rapid growth and development, as it is the crucial stage of establishing future. Gastro-intestinal disorders show high prevalence in pediatric practice. These conditions generally produce chronic illness. Grahanidosha is a disease related with Agnidushti. This condition is seen more in childhood period due to faulty dietary habit and changing lifestyle. The present paper deals with study on etiopathogenesis of Grahanidosha and evaluates the efficacy of Deavadarvyadi-Vati. The etiological factors and symptoms were observed carefully to make clear etiopathogenesis. Total 32 patients (3-12 years) were registered and randomly divided into two groups. In Group A Devadarvyadi-Vati (treated group) and in Group B Bhunimbadi-Vati (control group) given for 4 weeks with Koshna Jala. In Group A (Devadarvyadi-Vati), marked improvement was observed in 21.43% of the patients, moderate improvement was observed in 57.14% of patients and mild improvement was observed in 21.43% of patients.

BACKGROUND:

Hypertension is the leading risk factor for mortality worldwide. One-quarter of the adult Canadian population has hypertension, and more than 90% of the population is estimated to develop hypertension if they live an average lifespan. Reductions in dietary sodium additives significantly lower systolic and diastolic blood pressure, and population reductions in dietary sodium are recommended by major scientific and public health organizations.

OBJECTIVES:

To estimate the reduction in hypertension prevalence and specific hypertension management cost savings associated with a population-wide reduction in dietary sodium additives.

METHODS:

Based on data from clinical trials, reducing dietary sodium additives by 1840 mg/day would result in a decrease of 5.06 mmHg (systolic) and 2.7 mmHg (diastolic) blood pressures. Using Canadian Heart Health Survey data, the resulting reduction in hypertension was estimated. Costs of laboratory testing and physician visits were based on 2001 to 2003 Ontario Health Insurance Plan data, and the number of physician visits and costs of medications for patients with hypertension were taken from 2003 IMS Canada. To estimate the reduction in total physician visits and laboratory costs, current estimates of aware hypertensive patients in Canada were used from the Canadian Community Health Survey.

RESULTS:

Reducing dietary sodium additives may decrease hypertension prevalence by 30%, resulting in one million fewer hypertensive patients in Canada, and almost double the treatment and control rate. Direct cost savings related to fewer physician visits, laboratory tests and lower medication use are estimated to be approximately $430 million per year. Physician visits and laboratory costs would decrease by 6.5%, and 23% fewer treated hypertensive patients would require medications for control of blood pressure.

CONCLUSIONS:

Based on these estimates, lowering dietary sodium additives would lead to a large reduction in hypertension prevalence and result in health care cost savings in Canada.

The clinical behaviour and mean peak serum aspartate aminotransferase (SGOT) values of 106 patients admitted to a coronary care unit with acute myocardial infarction who displayed acute systolic hypertension were studied. Another 106 normotensive patients with acute myocardial infarction acted as controls. Neither group had established hypertension. The mortality rate, incidence of cardiac failure, major arrhythmias, and mean peak SGOT were significantly greater in the hypertensive group, within which the duration of hypertension was correlated with mean peak SGOT levels--through there was no definite relation between the height of systolic or diastolic pressure and SGOT. Transient systolic hypertension after acute myocardial infarction was therefore associated with a relatively poor prognosis, but our observations suggest that patients with a systolic blood pressure of at least 170 mm Hg might benefit from early hypotensive treatment.

In two Edmonton shopping centres 9591 people were screened for hypertension: 3.3% were found to be normotensive but taking antihypertensive medication and another 8.8% were found to have elevated blood pressure. Systolic hypertension alone accounted for 45.3% of the hypertensive cases and diastolic hypertension, with or without systolic, for 54%. Of the group with elevated blood pressure 34.5% had been previously unaware of their condition, 18.7% had never received medication for it, 18.2% had received medication in the past but had discontinued it, 26.1% were still on medication and 2.5% were not taking antihypertensive medication and were uncertain if they had ever done so in the past. Eighty-eight percent of the hypertensives who were receiving no medication went to their physician; 41% were prescribed antihypertensive medication, and 87% were still on treatment three months later and 74% one year after detection. Eighteen percent of those started on treatment had their medication discontinued by their doctor over the next year and 8% stopped treatment on their own. Of those hypertensives already receiving medication 88% went to their doctor and 33% had their medication altered.

Physician measurements of blood pressure tended to be lower than those recorded at the screening. At least part of the explanation for this discrepancy is that physicians often used blood pressure cuffs that were too wide for the patient's arm; 25% of the people screened required cuffs narrower than the standard cuff used by most physicians.

The prevalence of hypertension was similar among women taking oral contraceptives and women not taking these agents.

Hypertension is one of the most important clinical conditions affecting older people. Its prevalence in this group of subjects is above 60% and continues to grow. Isolated systolic hypertension accounts for the majority of cases as systolic blood pressure increases with advancing age, while diastolic blood pressure remains unchanged or even decreases. Nowadays hypertension is a well established risk factor for stroke and cardiovascular disease among older people and its treatment is considered mandatory. The general recommended blood pressure goal in uncomplicated hypertension is less than 140/90 mmHg, even if this target in older people is based mainly on expert opinion. All patients should receive nonpharmacological treatment, in particular reduction in excess body weight when body mass index is greater than 26 kg/m2 and dietary salt restriction. Older patients with hypertension may also benefit from smoking cessation, physical activity and alcohol restriction. In relation to drug therapy, a low-dose thiazide diuretic could be a good first step. Other first-line drugs are long-acting calcium channel blockers, generally dihydropyridines, and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. The HYVET study showed a specific protective effect of indapamide with or without perindopril in people older than 80 years. Since monotherapy normalizes blood pressure in only 40–50% of cases, a combination of two or more drugs is often required. Moreover the addiction of a second drug may reduce the dose-related adverse effects of the first one. Finally, compliance with treatment should always be achieved by giving complete information to patients and simplifying the drug regimen as much as possible.

Isolated systolic hypertension, an elevation in systolic but not diastolic pressure, is the most prevalent type of hypertension in those aged 50 or over, occurring either de novo or as a development after a long period of systolic‐diastolic hypertension with or without treatment. The increase in blood pressure with age is mostly associated with structural changes in the arteries and especially with large artery stiffness. It is known from various studies that rising blood pressure is associated with increased cardiovascular risk. In the elderly, the most powerful predictor of risk is increased pulse pressure due to decreased diastolic and increased systolic blood pressure. All evidence indicates that treating the elderly hypertensive patient will reduce the risk of cardiovascular events. However, there is no evidence yet for the very elderly. This population is particularly susceptible to side effects of treatments and the reduction of blood pressure, although reducing the risk of cardiovascular events such as stroke, may result in increased mortality.

Background:

Hypertension continues to be a major causative factor contributing to cardiovascular, cerebrovascular and renal morbidity and mortality.

Aim:

The objective of this study was to assess the prevalence, awareness and control of hypertension in the estate population in Johor, Malaysia.

Patients and Methods:

A mercury sphygmomanometer was used to record systolic and diastolic blood pressures. Cross sectional population survey was carried out in the study.

Results:

The overall prevalence of hypertension in 903 subjects studied was 26.91% (243). A higher prevalence 27.65 % (133) was found in males against 26.07% (110) in females. Awareness of the disease was present in only 39% (96) of which 86.45% (83) received treatment. Among those who received treatment, control of hypertension was present in 15.66% (13).

Conclusion:

The prevalence of hypertension among the estate population is lower than that of the general population of Malaysia, which can be attributed to their regular physical activity but the awareness, treatment, control and follow-up of patients is disappointingly low.

Background and Purpose

On average, systolic blood pressure (SBP) rises with age, while diastolic blood pressure (DBP) increases to age 50 and then declines. As elevated blood pressure is associated with cardiovascular disease and mortality, it also might be linked to frailty. We assessed the association between blood pressure, age, and frailty in a representative population-based cohort.

Methods

Individuals from the second clinical examination of the Canadian Study of Health and Aging (n = 2305, all 70+ years) were separated into four groups: history of hypertension ± antihypertensive medication, and no history of hypertension ± antihypertensive medication. Frailty was quantified as deficits accumulated in a frailty index (FI).

Results

SBP and DBP changed little in relation to age, except in untreated hypertension, where SBP declined in individuals >85 years. In contrast, SBP declined in all groups up to an FI of 0.55, and then rose sharply. DBP changed little in relation to FI. The slope of the line relating FI and age was highest in untreated individuals without a history of hypertension, indicating the highest physiological reserve.

Conclusions

SBP declined as frailty increased in older adults, except at the highest FI levels. SBP and age had little or no relationship.

Aims

Heavy drinking is associated with hypertension. This study evaluated blood pressure changes occurring during treatment for alcohol dependence.

Participants

Subjects included 1,383 persons participating in the COMBINE Study, a large multicenter treatment study for alcohol dependence.

Measurements

Methods appropriate for repeated measures data were used to assess the relationship of percent drinking days (PDD) to systolic and diastolic blood pressure (BP) over a 16 week treatment period. Modification of these associations by demographic and other variables was assessed.

Findings

Blood pressure reduction was evident only in persons who were above the median BP at baseline. In this group, systolic BP decreased by an average of 12 mm Hg, and diastolic BP decreased by an average of 8 mm Hg. BP reduction occurred during the first month of treatment. This effect was similar regardless of age, sex, body-mass index, reported history of hypertension, and use of anti-hypertensive medications. An observed association between BP and PDD in Caucasians was not evident in African Americans largely due to their lower pre-treatment BP.

Conclusions

Reduction in alcohol consumption has a potent anti-hypertensive effect in alcoholics with higher blood pressure. For hypertensive, alcohol-dependent persons, treatment for alcoholism should be considered a major component of anti-hypertensive therapy.

Background and Objectives

Morning hypertension is closely related to target organ damage and cardiovascular events. Little data is available concerning the baseline characteristics and comprehensive blood pressure analysis of hypertensive patients on treatment with morning hypertension.

Subjects and Methods

We evaluated 1,087 hypertensive patients who had taken stable anti-hypertensive medication at least 6 months. The enrolled patients measured their home blood pressure for 7 days. Baseline characteristics and the laboratory data were analyzed. Morning hypertension was defined as a morning blood pressure ≥135/85 mm Hg and systolic or diastolic blood pressure difference between morning and evening exceeding 10 mm Hg.

Results

One hundred seventy three patients with morning hypertension showed a preponderance of males, older patients, alcohol consumers, and greater waist circumference and waist-to-hip ratio despite the same body mass index. Impaired fasting glucose and metabolic syndrome were more prevalent in the patients with morning hypertension. The morning hypertensives took more anti-hypertensive drugs and displayed higher blood pressure in the clinic and at home.

Conclusion

The worse clinical variables and relatively poorly controlled blood pressure of those with morning hypertension supports a potential relationship of morning hypertension with poor cardiovascular outcome. Morning blood pressure should be monitored at home for the optimal treatment of hypertension.

Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary condition that may be diagnosed in utero. Our goal was to evaluate symptoms of ADPKD in children, including left ventricular mass index (LVMI), renal volume, renal function and microalbuminuria in relation to systolic and diastolic blood pressure. Eighty-five children were stratified by blood pressure into three cohorts: hypertensive (95th percentile and over), borderline hypertensive (75–95th percentile) and normotensive (75th percentile and below). There were no differences in gender, age, height, renal function, or microalbuminuria between the groups. Both the hypertensive and borderline hypertensive children had a significantly higher LVMI than normotensive children, with no significant difference between hypertensive and borderline hypertensive groups. There was a significant correlation between renal volume and both systolic and diastolic blood pressures in all subjects. Renal volume in hypertensive children was significantly larger than in the borderline hypertensive group, with no significant difference between normotensive and borderline hypertensive groups. These findings show that an increase in LVMI may be detected earlier than an increase in renal volume in children with ADPKD and borderline hypertension, suggesting that close monitoring of cardiac status is indicated in these children.

More than half of elderly men and women have hypertension, leading to a significant risk of increased morbidity and mortality. The cause of hypertension in this age group is unknown. Left ventricular hypertrophy is frequently present, often associated with diastolic dysfunction. Systolic hypertension in the elderly increases the risk of cardiovascular disease, but there are no good data to show that the treatment of isolated systolic hypertension reduces the morbidity or mortality. Good evidence indicates that antihypertensive treatment in this group decreases cardiovascular morbidity and mortality up to age 80, so most elderly hypertensive patients should be treated. An empiric trial of nonpharmacologic therapy can be initiated in those with mild hypertension and no cardiovascular disease, but most patients will require drug therapy. Most elderly hypertensive patients have accompanying illnesses for which they may or may not be taking medications. Some antihypertensive drugs exacerbate coexisting diseases while others augment treatment regimens. Similarly, drugs may interact in a beneficial or adverse way. Finally, drug metabolism is altered by age, leading to problems with toxicity or diminished efficacy. The choice of medication should be based on all such considerations, including the cost and convenience of the drugs available.