Beta-adrenoceptor-blocking drugs in the elderly

Beta-adrenoceptor function appears to be diminished in the elderly, although the exact mechanisms are still uncertain. Some evidence suggests that this attenuation is predominantly of beta1-receptor activity, with beta2-receptor activity remaining intact. Pharmacokinetic changes also occur in the elderly with beta-blockers. Absorption is unchanged but bioavailability may be increased, particularly with lipophilic drugs such as propranolol that are subject to "first-pass" effects. Both hepatic and renal clearance may be diminished, and this suggests that, in general, elderly patients will require smaller doses than those normally given to younger ones. Although antihypertensive response to beta-blockers has been linked to renin status, clinical trial evidence indicates that beta-blockers are effective antihypertensive agents in the elderly, and clinical experience suggests that this is true also for ischemic heart disease. Provided attention is given to patient selection, associated diseases, and dosage, in general, beta-blockers appear to be well tolerated in the elderly. However, careful clinical supervision is required, particularly during treatment initiation.