Isolated Systolic Hypertension in the Elderly

Copyright © 2007 Massachusetts Medical Society. A 68-year-old accountant visits his physician. He was told a year earlier that his blood pressure was somewhat elevated and was advised to reduce salt intake and increase physical activity. Otherwise he has been in good health and has no history or signs of cardiovascular or renal disease. On physical examination, his blood pressure is 178/72 mm Hg, with no clinically significant differences between arms or on standing. He has a body-mass index (the weight in kilograms divided by the square of the height in meters) of 28.4. The examination is otherwise unremarkable. Urinalysis is normal. The nonfasting blood glucose level is 98 mg per deciliter (5.4 mmol per liter), serum potassium 4.2 mmol per liter, and creatinine 1.2 mg per deciliter (106 μmol per liter). How should he be further evaluated and treated?