The differential efficacy of antihypertensive agents in the elderly

A number of controlled trials have shown that antihypertensive therapy is beneficial to the elderly (greater than or equal to 60 years of age). Even so, there may be deleterious age-related effects associated with such therapy. Because of physiological and pathophysiological problems peculiar to the elderly (many of which remain to be defined precisely), both benefits and untoward effects of antihypertensive drugs differ, sometimes within classes of agents themselves. None of the traditional agents is ideal for the management of hypertension in the elderly. Differential efficacy and tolerability of various antihypertensive agents has often been claimed but none of these claims appears established beyond dispute. Increasing evidence, however, suggests that the serotonin antagonist ketanserin may be more effective and better tolerated in elderly hypertensives. If the elderly are to derive maximum benefit from antihypertensive therapy, the question of age-related differential effects of agents used needs to be addressed in carefully designed studies to determine the nature and magnitude of such effects, where they exist and what clinical implications they may have.