Age and pathophysiology-oriented antihypertensive response to calcium antagonists

Ageing is associated with pathophysiological adaptive changes in cardiovascular regulation including reduced baroreflex sensitivity and beta-adrenoceptor-mediated cardiac and renal responses. Accordingly, owing to such blunted counterregulation, older patients gain a greater fall in blood pressure for a given peripheral vasodilation, e.g., with a calcium antagonist. Such age-related efficacy may be helped by the calcium antagonist's renal and antialdosterone effects resulting in natriuresis. In open and double-blind treatment trials, calcium antagonists in monotherapy were more effective in reducing blood pressure to normal in older patients with hypertension and, for the same reasons, those with a low plasma renin activity or of black race; pretreatment blood pressure was another independent predictor. Age as well as renin and black race help to design antihypertensive treatment strategies with better blood pressure control and better well-being of the patient.