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Treatment of hypertension in the elderly--what have we learned from the recent trials?
1Department of Cardiology, University of Bergen, School of Medicine, Norway.
Insights
Drug treatment for hypertension in elderly adults (65-85 years) significantly reduces stroke risk. Combined therapy with diuretics and beta-blockers is often necessary, with careful potassium monitoring recommended.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Elderly hypertension treatment historically relied on clinical judgment due to limited large-scale trials.
- Recent large trials (STOP-Hypertension, SHEP, MRC) provide crucial data on treating hypertension in older adults.
- Focus on permanent diastolic and isolated systolic hypertension in individuals aged 65-85.
Discussion:
- Drug therapy, particularly combined diuretics and beta-blockers, effectively lowers stroke incidence in the elderly.
- Thiazide diuretics necessitate close serum potassium monitoring; amiloride co-administration is advised, as seen in STOP and MRC trials.
- Careful clinical evaluation is essential to select antihypertensive agents, considering comorbidities that may contraindicate certain drug classes.
Key Insights:
- Pharmacological intervention in elderly hypertension demonstrably reduces stroke incidence.
- Combined diuretic and beta-blocker therapy is a common and effective treatment strategy.
- Individualized treatment selection is paramount due to potential contraindications in elderly patients.
Outlook:
- Newer antihypertensive classes (calcium antagonists, ACE inhibitors, alpha-blockers) may offer improved side effect profiles.
- Long-term morbidity and mortality data for newer antihypertensive agents in the elderly are still needed.
- Further research should focus on the long-term efficacy and safety of novel treatments in this demographic.
Abstract:
Treatment of hypertension in the elderly has so far mainly been based on clinical judgment and very few large controlled trials. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP, and MRC trials. All have shown that drug treatment of hypertension in the elderly (65-85 years) with permanent diastolic hypertension or isolated systolic hypertension reduces stroke incidence. Most patients have needed combined drug treatment with diuretics and beta-blockers. When thiazide diuretics are used, serum potassium should be followed very closely and most likely amiloride should be added to the thiazide therapy, since this was done both in the STOP and the MRC trials. Since many elderly patients with hypertension suffer from other diseases that might represent contraindications to thiazide diuretics or beta-blockers, the choice of drug must be made after careful clinical evaluation. With the newer classes of antihypertensive agents (calcium antagonists, ACE inhibitors and alpha-blockers) side effects are probably seen less often, but long-term data on morbidity and mortality are still lacking.