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Hypertension is present in most individuals older than 65 years. Treatment recommendations for patients in this age group are generally the same as for others with hypertension. In older patients with isolated systolic hypertension, the preferred treatment is a diuretic with or without a β- blocker, or a dihydropyridine CCB alone. Diastolic BP less than 75 mm Hg increases these patients’ risk of stroke and should be avoided.Antihypertensive drug therapy in older patients can cause adverse effects that increase the risk of falls, such as dizziness and hypotension. Appropriate precautions should be taken to reduce this risk and enhance patient safety.

Dementia occurs more commonly in individuals with hypertension. In some patients,antihypertensive therapy may slow the progression of cognitive impairment.Hypertension in women who are pregnant can potentially increase maternal and fetal morbidity and mortality. The possible adverse effects of antihypertensive drug therapy on fetal development must be considered, however, when pharmacologic treatment is planned. Methyldopa, β-blockers, and vasodilators are the recommended drugs for treatment of hypertension in pregnancy. ACE inhibitors and ARBs are contraindicated in pregnancy because of teratogenic effects; they should also be avoided in women who are likely to become pregnant. Considerable advances have been made in the detection, evaluation, and management of hypertension in children and adolescents. Current evidence indicates that primary hypertension in young individuals occurs more commonly than previously recognized and has substantial longterm health implications. There is little doubt that obesity in young people is a predictor for developing hypertension as well as associated metabolic risk factors. Hypertension in individuals aged 3–18 years is defined as average systolic BP and/or diastolic BP that is in the 95th percentile or higher for sex, age, and height, taken on 3 or more occasions. BP between the 90th 85 percentile and the 95th percentile in childhood is designated as elevated and is an indication for lifestyle modifications. It is recommended that children older than 3 years have their BP measured when they are examined in a medical setting.