Pharmacologic treatment of the elderly hypertensive: comparative efficacy and side effects

Because of the physiologic changes associated with aging, a nonpharmacologic approach is recommended as initial therapy for the elderly hypertensive. Approximately 80% of this patient population, however, requires pharmacologic therapy, as well. When initiating drug treatment, the physician should remember several guidelines and have some understanding of the mechanisms of action of the available agents. The four drug classes recommended by JNC IV for the treatment of high blood pressure are quite similar in effectiveness. Low-dose diuretics, however, particularly when combined with a potassium-sparing agent, produce significantly fewer adverse reactions than seen with the other classes of drugs. This advantage, coupled with their low cost, makes diuretics the reasonable first choice for the treatment of older hypertensives.