Influence of age on general practitioners' definition and treatment of hypertension

Recent guidelines on management of hypertension may unwittingly have focused some attention on the question of when treatment should start in younger patients. Although younger patients have a high relative risk of premature vascular disease,1 they gain little from treatment in short term studies. The implication from the Medical Research Council trials of treatment in hypertension2 3 and the British Hypertension Society guidelines4 is that the cut off point for treatment falls from a diastolic blood pressure of 100 mm Hg in younger patients without coexistent risk factors to one of 90 mm Hg in elderly patients (see figure). Since general practitioners manage most patients with hypertension we investigated whether current practice mirrors existing guidelines and, in particular, whether the cut off point for treatment changes with patient age.