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Hypertension in the elderly with coexisting benign prostatic hyperplasia.
J Maruenda1, V Bhatnagar, D T Lowenthal
1University of Florida College of Medicine and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Gainesville 32608-1197, USA.
Urology
|March 27, 1999
Summary
Low-dose diuretics effectively treat hypertension in elderly patients. For men with prostatism, tamsulosin offers a safe option, avoiding blood pressure changes when combined with diuretics.
Area of Science:
- Geriatric Medicine
- Cardiology
- Urology
Background:
- Hypertension management in the elderly requires careful consideration of comorbidities.
- Men with prostatism often require alpha-blocking agents, which can impact blood pressure.
- Concomitant use of diuretics and certain alpha-blockers may increase the risk of orthostatic hypotension.
Purpose of the Study:
- To evaluate the safety and efficacy of low-dose diuretic therapy for hypertension in the elderly.
- To assess the suitability of tamsulosin for elderly men with hypertension and prostatism.
- To identify optimal antihypertensive strategies for this patient population.
Main Methods:
- Review of existing literature on antihypertensive therapies in the elderly.
- Analysis of the pharmacological profiles of diuretics, alpha-blockers (doxazosin, terazosin, tamsulosin), and other antihypertensives.
- Consideration of drug interactions, particularly with low-dose diuretics.
Main Results:
- Low-dose diuretic therapy is safe and effective for elderly hypertension, including isolated systolic and fixed diastolic hypertension.
- Tamsulosin relaxes prostate smooth muscle without causing significant blood pressure changes or orthostatic hypotension.
- A combination of low-dose hydrochlorothiazide and tamsulosin appears to be an adequate treatment for elderly patients with hypertension and prostatism.
Conclusions:
- Low-dose diuretics are a cornerstone for managing hypertension in the elderly.
- Tamsulosin is a preferred alpha-blocker for men with prostatism and hypertension due to its favorable hemodynamic profile.
- Careful selection of additional antihypertensives (calcium-entry blockers, ACE inhibitors, ARBs) is recommended when necessary, considering potential interactions.