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Hypertension in the elderly
1Institut de Recherches Cliniques de Montréal, Hôtel-Dieu de Montréal, Quebec, Canada.
Insights
Elderly hypertension management is crucial for reducing cardiovascular mortality. While systolic pressure is key in older adults, more research is needed on long-term benefits of newer agents like calcium channel blockers.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Cardiovascular disease (CVD) significantly impacts the elderly, with hypertension as a primary risk factor.
- Systolic blood pressure is increasingly recognized as a critical risk factor for CVD complications in older adults.
- Existing drug trials suggest hypotensive treatments can reduce cardiovascular and cerebrovascular mortality in the elderly.
Purpose of the Study:
- To review the current understanding of hypertension management in the elderly.
- To evaluate the role of different antihypertensive drug classes in this population.
- To identify gaps in knowledge regarding long-term treatment efficacy, particularly for newer agents.
Main Methods:
- Review of existing intervention drug trials in elderly hypertensive patients.
- Analysis of studies on the efficacy and safety of antihypertensive medications, including older and newer agents.
- Examination of pharmacokinetic data in elderly populations.
Main Results:
- Diuretic combinations and beta-blockers have been studied, with some evidence of mortality reduction.
- Calcium antagonists show potential efficacy in the elderly, but further validation is required.
- Limited pharmacokinetic data suggests reduced clearance in the elderly; Nifedipine Retard shows promise but lacks long-term outcome data.
Conclusions:
- Hypotensive drug treatment can decrease cardiovascular mortality in the elderly, primarily through reduced cerebrovascular events.
- The long-term benefits of newer agents like ACE inhibitors and calcium channel blockers in elderly hypertension require further investigation.
- More clinical trials are needed to establish the definitive role and long-term efficacy of specific agents, such as nifedipine, in managing hypertension in older adults.
Abstract:
Cardiovascular disease in all its clinical manifestations progresses significantly as age advances and takes its heaviest toll in the elderly. Hypertension becomes the dominant risk factor for cardiovascular disease in this age group because of its high incidence. Traditionally, diastolic rather than systolic blood pressure has been regarded as the main risk factor for cardiovascular complications in hypertension, although it is becoming clearer that the risk of cardiovascular complications is likely to be associated mainly with systolic pressure in the elderly. Various intervention drug trials in elderly patients seem to indicate that hypotensive drug treatment can decrease cardiovascular mortality, mainly by decreasing cerebrovascular mortality. The EWPHE used a diuretic combination with methyldopa, and the HEP study used atenolol with a thiazide diuretic. The multicenter Systolic Hypertension in the Elderly Program (SHEPS) currently underway in the United States is likely to also provide some answers. The place of newer agents such as ACE inhibitors or calcium antagonists is still undetermined. Calcium antagonist drugs have been reported to be effective, and possibly more so in the elderly than in a younger population, although this assumption is not proven and may not be valid. Pharmacokinetic studies in the elderly are very few, although the studies reported indicate a reduced clearance. Studies also indicate that Nifedipine Retard tablets are effective, with a low incidence of adverse effects. There are no trials, however, looking at the long-term benefit of treating elderly hypertensive patients with either nifedipine tablets or other calcium-channel blockers.