Strict control [ systolic BP ( SBP ) < 140 mmHg ] was not consistently better than mild control ( SBP < 150 mmHg ) for adults aged ≥65 years .
Mild SBP control benefitted subjects in all age ranges over 65 years .
Conclusions In this review , older adults with hypertension had decreased cardiovascular morbidity and mortality  with antihypertensives compared with no treatment .
Strict control was not consistently better than mild control in older adults .
The current evidence is insufficient to determine the safest , most beneficial hypertension regimen in older adults
Background Hypertension increases with increasing age .
Optimal treatment of hypertension is important to reduce cardiovascular disease .
Recent guidelines for hypertension have made recommendations for older adults but are supported by evidence that includes younger individuals .
This systematic review evaluates the benefits and harms of antihypertensive agents in adults aged ≥65 years .
Antihypertensive efficacy and side effects of three beta‐blockers and a diuretic in elderly hypertensives: a report from the STOP‐Hypertension study
Objective : To compare the blood pressure‐lowering efficacy , the frequency of side effects and changes in laboratory values of three & bgr;‐blockers and a potassium‐sparing diuretic combination in elderly hypertensive patients . Design : The Swedish Trial in Old Patients with Hypertension ( STOP‐Hypertension ) was a prospect i ve , r and omized , double‐blind , multicentre trial comparing active antihypertensive treatment with placebo in patients aged 70‐84 years . Methods : The study group consisted of 1627 elderly hypertensive patients ( mean ± SD age 75.7 ± 3.7 years ; 37 % males , 63 % females ) . Supine and st and ing blood pressure , heart rate and side effects were recorded at each visit . Blood was drawn for routine analysis . The mean length of follow‐up was 25 months ( range 6‐65 ) . No patient was lost to follow‐up . Results : After 2‐months ' single‐drug therapy , all four active drugs were found to be equally effective in reducing diastolic blood pressure ( DBP ) . However , there were differences in their efficacy in reducing systolic blood pressure ( SBP ) ; the diuretic was significantly more effective than the & bgr;‐receptor blockers . The results of a series of multiple linear regression analyses showed that the observed differences in effect on SBP could not be explained by the different effects of the drugs on heart rate . More than two‐thirds of the patients were given supplementary treatment , most of them already by the 2‐month visit , after which there was no significant difference in blood pressure among the treatment regimens . The changes in laboratory values and in the prevalence of symptoms were minor for all four regimens . Conclusion : Metoprolol ( controlled release ) , atenolol , pindolol and the combination hydrochlorothiazide + amiloride were equally effective as single drugs in reducing DBP . There were differences in their efficacy in reducing SBP , the diuretic being more effective than the & bgr;‐blockers . After addition of supplementary treatment ( & bgr;‐blocker to diuretic , or vice versa ) there were no significant differences in blood pressure reduction among the groups . The changes in laboratory values and in the prevalence of symptoms were minor for all active treatment regimens . Thus , the satisfactory effect on cardiovascular morbidity and mortality was not impaired by low tolerability of the drugs
Strict control [ systolic BP ( SBP ) < 140 mmHg ] was not consistently better than mild control ( SBP < 150 mmHg ) for adults aged ≥65 years .
Mild SBP control benefitted subjects in all age ranges over 65 years .
Conclusions In this review , older adults with hypertension had decreased cardiovascular morbidity and mortality  with antihypertensives compared with no treatment .
Strict control was not consistently better than mild control in older adults .
The current evidence is insufficient to determine the safest , most beneficial hypertension regimen in older adults
Background Hypertension increases with increasing age .
Optimal treatment of hypertension is important to reduce cardiovascular disease .
Recent guidelines for hypertension have made recommendations for older adults but are supported by evidence that includes younger individuals .
This systematic review evaluates the benefits and harms of antihypertensive agents in adults aged ≥65 years .