We are an aging population. It is estimated that 20% of people in Europe will be over 65 years of age in the year 2000. The proportion of the population over 80 years, the so-called “old old”, is increasing most rapidly. Life expectancy at all ages is also increasing. At 65 years life expectancy ranges from 14.9 to 18.9 years and at 80 years from 6.9 to 9.1 years for men and women, respectively. Cardiovascular disease is the most frequent single cause of death in persons over 65 years of age1, and most importantly it is responsible for considerable morbidity and a large burden of disability, particularly in the community.

Cardiovascular pathologies such as hypertension and cerebrovascular disease, and heart diseases such as coronary artery disease, arrhythmias, and heart failure, increase in incidence with increasing age.^w1 The aging process itself also effects the cardiovascular system. It is difficult to differentiate “normal” aging, which is inevitable, from age related pathology, which is potentially preventable or treatable.^w2 Age related changes are most likely to be seen in the “old old” who have escaped cardiovascular pathology earlier in life. This group demonstrates the dual processes, often interacting, of biological aging of the cardiovascular system and age related pathology. This combination modifies the pathophysiology of disease such that knowledge of that condition and treatment thereof, derived from studies in “young old” (65–75 years) are not readily applicable to the “old old”. Older patients differ from “trial” patients of any age by virtue of their other comorbidities and multiple drug usage, which are invariably exclusion criteria for entering treatment studies.