pressure and its management directed toward elderly persons, health care professionals, and policymakers. The chapter does not discuss details of clinical diagnosis or treatment because these issues have been recently reviewed elsewhere.7

BURDEN

Several epidemiologic studies have indicated that, in most countries, average systolic blood pressure increases throughout the life span whereas average diastolic blood pressure rises until ages 55 to 60 and then levels off.38 This increase in blood pressure occurs in persons who have previously been classified as hypertensive and those classified as normotensive. However, data from the Framingham longitudinal research and other studies indicate that not all individuals experience an aging-related increase in blood pressure.38 In addition, population studies from nonindustrialized societies indicate that average blood pressure among such groups does not tend to rise with age.51

Estimates of the true prevalence of high blood pressure vary greatly depending on the age and race of the population, the blood pressure level used to define hypertension, and the number of measurements made.15 The prevalence of both systolic/diastolic high blood pressure and isolated systolic high blood pressure is considerable in persons over the age of 50. Because levels of diastolic blood pressure tend to level off around age 55, the prevalence of systolic/diastolic high blood pressure tends to be constant for persons aged 50 and older.25 Therefore, although some authors speak in general terms of the rise in prevalence of high blood pressure with age, the prevalence of systolic/diastolic high blood pressure rises little with age.50 Actually, it is the rise in isolated systolic high blood pressure that accounts for most of the overall increase; the prevalence of systolic/diastolic high blood pressure in persons over the age of 50 is about 15 percent in whites and 25 percent in blacks.33 The prevalence of isolated systolic high blood pressure varies with increasing age from 1 or 2 percent at age 50 to greater than 20 percent over age 8032,50,57 and does not appear to differ according to race. Therefore, the total prevalence of high blood pressure in the elderly is not quite as high as the 50 to 60 percent figure that is frequently reported.63

Unfortunately, there are only limited data to estimate the rate of onset of new incidence cases of high blood pressure in the elderly. Follow-up analyses of the National Health and Nutrition Examination Survey 1 (NHANES1) data indicate that the incidence of high blood pressure (defined as SBP > 95 mmHg, based



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