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To the Editor: Defining uncontrolled hypertension in the elderly in a clinically meaningful way is complex. First, there is no strong evidence to show the benefit of treating elderly persons with mild systolic hypertension.¹ This is consistent with the results of the study on hypertension in adults by Dr Lloyd-Jones and colleagues² in which the fully adjusted hazard ratios for all adverse events in patients with stage 1 hypertension crossed 1 in all elderly age groups. Second, treating the oldest old patients with hypertension reduces the risk of ischemic stroke, but increases mortality.³

These findings imply that current guidelines may not be applicable to elderly persons with mild hypertension. However, such guidelines have been used to define uncontrolled hypertension in this group by Lloyd-Jones et al and others,^{2, 4} and this might be misleading. The majority of elderly patients with uncontrolled hypertension have isolated mild systolic hypertension.⁴ Randomized controlled trials for . . . [Full Text of this Article]

Huai Yong Cheng, MD, MPH
hyc2105@columbia.edu
Department of Medicine
Columbia University Medical Center
New York, NY

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