Increasing complexity: which drug class to choose for treatment of hypertension in the elderly?

Area of Science:

• Gerontology
• Cardiology
• Pharmacology

Background:

• Hypertension management in the elderly is increasingly complex.
• Current clinical trial evidence and guidelines offer inconclusive recommendations for elderly hypertension treatment.

Purpose of the Study:

• To review the latest evidence (2013) on optimal blood pressure targets and preferred antihypertensive agents for the elderly.
• To discuss challenges in treating hypertension in the very elderly and present current guideline recommendations.
• To evaluate the advantages, medical, and economic implications of various drug classes in elderly patients.

Main Methods:

• Review of evidence from studies available up to 2013.
• Analysis of current guidelines: NICE 2011, JNC7 (2013 update), ESH/ESC 2013, CHEP 2013, JNC8, ASH/ISH.
• Discussion of six main drug classes: diuretics, beta-blockers (BBs), calcium channel blockers (CCBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and direct renin inhibitors (DRIs).

Main Results:

• All current antihypertensive drug classes demonstrate equal efficacy regarding cardiovascular outcomes.
• Selection should consider drug benefits beyond blood pressure reduction.
• Combination therapy with ACEIs and diuretics is favorable for systolic/diastolic hypertension.
• Diuretics are cost-effective combination agents; CCBs are recommended with diuretics for isolated systolic hypertension.
• ACEIs and CCBs are beneficial for patients with dementia; CCBs and ARBs offer cost savings through adherence.

Conclusions:

• Individualized antihypertensive therapy selection is crucial for the elderly, considering efficacy, side effects, and collateral benefits.
• Combination therapy, particularly ACEIs with diuretics or CCBs with diuretics, shows promise.
• Cost-effectiveness and adherence are important factors in drug selection for elderly hypertensive patients.