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In their thorough analysis of the treatment of hypertension in elderly nursing home residents, Gambassi and colleagues¹ concluded that the current prescription pattern with a predominance of calcium antagonists and angiotensin-converting enzyme inhibitors at the expense of -blockers did not follow recommended guidelines. As an explanation for this discrepancy, they suggest that "the present findings may reflect appropriate prescribing by an enlightened physician facing the difficult applicability of the guidelines to the frail, very old nursing home resident with multiple comorbid conditions and concomitant, complex pharmacological regimens." We can only reemphasize these thoughts. As can be seen in Table 1, ^2-6 there is a distinct difference between the "healthy" elderly patients with hypertension (such as those included in the SHEP [Systolic Hypertension in the Elderly Program], Syst-Eur [Systolic Hypertension in Europe], or Syst-China [Systolic Hypertension in the Elderly Chinese Trial] studies) and even the normotensive elderly population, not to speak . . . [Full Text of this Article]

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