What is the first-line treatment option for isolated systolic hypertension in elderly patients?

• A. High-dose thiazide diuretics
• B. ACE inhibitors
• C. Low-dose thiazide diuretics or calcium channel blockers
• D. Beta blockers

Answer: (C)

Isolated systolic hypertension in the elderly is driven by arterial stiffness, so first-line management targets lowering the systolic pressure with agents that are effective and well tolerated in older adults. A low-dose thiazide diuretic or a calcium channel blocker is preferred. Thiazides, particularly when used at low doses, reduce blood pressure with solid cardiovascular outcome data in older patients, while minimizing electrolyte disturbances; long-acting options like chlorthalidone are often favored for their CV benefits. Calcium channel blockers, especially the long-acting dihydropyridines, ease arterial stiffness and lower SBP with good tolerability. Avoid high-dose diuretics as first-line due to greater risk of dehydration and electrolyte imbalances in the elderly. ACE inhibitors and beta blockers can be appropriate in certain comorbid conditions, but they are not the preferred initial therapy specifically for isolated systolic hypertension unless there’s another compelling indication.