It is estimated that more than half of the people aged 65 and above around the world have some form of hypertension, or high blood pressure. Hypertension is a common condition in older people. When people get older, the changes in the structure of walls of blood vessels make them harder or stiffer. These changes produce loss of vascular compliance (sponginess).

The risk of heart failure, kidney failure, stroke, coronary heart disease, and heart attack is getting higher for older people with hypertension. According to many clinical studies, lowering of blood pressure can actually minimize these complications. Treating hypertension in older persons can have a greater benefit than in younger patients.

At least two types of hypertension can be seen in elderly: regular hypertension and isolated systolic hypertension. When both the higher (systolic) and lower (diastolic) blood pressure readings are above the normal range, that is, greater than 140/90 mmHg, the person is having regular hypertension. Isolated systolic hypertension occurs when only the systolic blood pressure reading is higher while the diastolic reading is normal, that is, systolic is greater than 140 mmHg but diastolic is less than 90 mmHg.

For elderly, isolated systolic hypertension is more common, more aggressive and is associated with an increased risk of complications.

White coat hypertension and postural hypotension are two common situations found among elderly. The former is a situation when a patient's blood pressure reading is only elevated when taken by a doctor in a clinic otherwise it is normal. The latter occurs during a change of posture such as changing from a sitting to a standing position: there is a drop in systolic blood pressure of more than 20 mmHg. This may also be accompanied by giddiness, blurring of vision or even faintness. Therefore, it is essential to measure blood pressure immediately and 2 minutes after the patient stands up.

There is no much difference in treating elderly and younger hypertension patients, except with minor adjustments in some cases. This include lifestyle modifications like eating a healthy balanced diet, regular exercise, smoking cessation, maintaining one's healthy body weight, and of course drug therapy.

Beliefs that older persons do not tolerate hypertensive treatment well, do not benefit from treatment, or need a higher blood pressure than younger persons in order to maintain good health are merely misconceptions.

Research has shown that older people can also tolerate medications well if these modifications are introduced gradually. They can in fact derive more treatment benefits than younger persons. They can live longer if their blood pressure remains within the normal range, that is, less than 140/90 mmHg.