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The management of hypertension in older patients
1Center for Aging, University of Alabama, Birmingham 35294.
Insights
Hypertension is common in older adults but treatable. Quinapril, an angiotensin-converting enzyme (ACE) inhibitor, is effective and safe for elderly patients, comparable to younger individuals. Lower starting doses are recommended due to potential renal impairment.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Hypertension is prevalent in aging populations, with significant cardiovascular risks.
- Effective treatments exist for elevated diastolic blood pressure, reducing mortality.
- Angiotensin-converting enzyme (ACE) inhibitors are a key therapeutic class.
Purpose of the Study:
- To evaluate the efficacy and safety of quinapril in older hypertensive patients.
- To compare quinapril's effects in older versus younger patient populations.
- To determine optimal dosing strategies for quinapril in the elderly.
Main Methods:
- Double-blind, long-term, open-label studies were conducted.
- 451 older patients were compared with 1,887 younger patients.
- Quinapril was administered as the study drug for hypertension management.
Main Results:
- Quinapril demonstrated equal efficacy in both older and younger patient groups.
- Safety profiles were comparable between age groups, with similar adverse event rates and types.
- Older patients require lower initial quinapril doses (5 mg) due to potential renal impairment.
Conclusions:
- Quinapril is an effective and safe ACE inhibitor for treating hypertension in older adults.
- Its comparable safety and efficacy to younger patients support its use in geriatric populations.
- Consideration of renal function and lower starting doses are crucial for quinapril therapy in the elderly.
Abstract:
Hypertension need not be a natural consequence of aging; nevertheless, as many as 70% of individuals aged 70 years or more have diastolic blood pressures greater than or equal to 90 mm Hg and/or systolic blood pressures greater than 160 mm Hg. Well-controlled trials have documented significant reductions in cardiovascular mortality with treatment of diastolic elevation. Double-blind, long-term, open-label studies have been conducted of quinapril, a new angiotensin-converting enzyme (ACE) inhibitor, in 451 older patients compared with 1,887 younger patients. Results of these studies showed that quinapril is equally effective in older and younger patients. The studies also demonstrated that the safety of quinapril in the treatment of older patients is comparable with that in younger patients, in terms of both the incidence of adverse events and the types of adverse events reported. However, because many older patients have impaired renal function, which can prolong the half-life of renally excreted ACE inhibitors such as quinaprilat (the active metabolite of quinapril), they should be started on lower doses of quinapril (5 mg) than are used in younger patients. The shorter half-life and duration of action of quinaprilat compared with other once-daily ACE inhibitors may make quinapril better suited than these other agents for use in older patients.