Systolic hypertension above > 160 mmHg is associated with cardiac, renal and cerebrovascular complications. In older people, treating hypertension offers cardiovascular benefits. Reduced salt intake and weight loss for obese older people improves blood pressure without any risk of adverse drug reactions. Blood pressure reduction is more important than the type of antihypertensive for cardiovascular risk reduction. The recommended drugs to start an older patient with isolated systolic hypertension are thiazides, calcium-channel blockers or angiotensin II receptor blocker. Studies were performed on relatively fit older patients, so benefits may not be generalisable to frail elderly. Alpha-blockers and beta-blockers are not recommended for first line therapy of hypertension but may be considered if there are other indications for their use.
Nay Thu Win, Shyh Poh Teo, Management of Hypertension in Older People Journal of the Hong Kong College of Cardiology 2017;25(1) https://doi.org/10.55503/2790-6744.1017