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A rational approach to the treatment of hypertension in special populations
1Emory University School of Medicine, Atlanta, Georgia, USA.
Insights
Blacks with hypertension often have low renin and respond well to diuretics or calcium channel blockers. Treatment guidelines for older adults focus on isolated systolic hypertension and combined hypertension in specific age groups.
Area of Science:
- Cardiology
- Nephrology
- Geriatrics
Background:
- Hypertension in Black individuals typically presents with low renin, expanded volume, and salt sensitivity.
- Older adults commonly experience isolated systolic hypertension (ISH) or combined systolic and diastolic hypertension (SHTN).
Purpose of the Study:
- To review the optimal management strategies for hypertension in Black patients.
- To outline evidence-based treatment recommendations for hypertension in older adults, differentiating between ISH and SHTN.
Main Methods:
- Literature review of studies on hypertension management in specific populations.
- Analysis of treatment responses to various antihypertensive drug classes, including diuretics, calcium channel antagonists, beta-blockers, and ACE inhibitors.
- Evaluation of clinical trial data supporting hypertension treatment in older adults (60-96 years).
Main Results:
- Diuretics and calcium channel antagonists show good efficacy as initial therapies for hypertension in Black patients.
- Beta-blockers and angiotensin-converting enzyme (ACE) inhibitors demonstrate blunted responses in monotherapy for Black patients, but efficacy improves with diuretics.
- Strong evidence supports treating combined hypertension in patients aged 60-79 and ISH in patients aged 60-96.
- Diuretics and long-acting dihydropyridine calcium channel antagonists are recommended for ISH in older adults.
Conclusions:
- Tailored antihypertensive strategies are crucial for Black patients, favoring diuretics or calcium channel blockers.
- Established guidelines exist for treating hypertension in older adults, particularly ISH and combined hypertension within specific age brackets.
- Further research is needed to establish treatment guidelines for combined hypertension in individuals aged 80 and older.
Abstract:
Hypertension in blacks is usually characterized by low renin, expanded volume and sensitivity to salt. Diuretics are the preferred initial therapy, but response to calcium channel antagonists is also good. The blood pressure response to monotherapy with beta blockers or angiotensin-converting enzyme (ACE) inhibitors is blunted, but this effect is abolished with concomitant use of diuretics. The two major types of hypertension in older persons are isolated systolic hypertension and combined systolic and diastolic hypertension. Strong data support the treatment of combined hypertension in patients 60 to 79 years of age and isolated systolic hypertension in patients 60 to 96 years of age. Diuretics and long-acting dihydropyridine calcium channel antagonists are the recommended initial therapies for isolated systolic hypertension. More studies are necessary before recommendations can be made about the treatment of combined hypertension in patients 80 years of age and older.