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Hypertension in the aging patient. Implications for the selection of drug therapy
M Bursztyn1, I Gavras, H Gavras
1Department of Medicine, Boston City Hospital, Massachusetts.
Insights
Treating hypertension in elderly patients is now recommended, as controlling high blood pressure reduces cardiovascular and cerebrovascular events. Newer drugs like ACE inhibitors and calcium channel blockers are effective first-line therapies due to their favorable profiles.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Elderly patients with hypertension face unique challenges due to hemodynamic and biochemical characteristics.
- Systolic hypertension is a key concern in this population, correlating strongly with complications.
Purpose of the Study:
- To evaluate the necessity and efficacy of hypertension treatment in the elderly.
- To identify optimal antihypertensive agents for older adults, considering safety and quality of life.
Main Methods:
- Review of recent multicenter trials on hypertension management in elderly populations.
- Analysis of drug classes, focusing on side effect profiles and patient characteristics.
Main Results:
- Hypertension control in the elderly significantly reduces cardiovascular and cerebrovascular events.
- Elderly patients are vulnerable to side effects of many common antihypertensive drugs.
Conclusions:
- Angiotensin-converting enzyme inhibitors and calcium channel blockers are recommended as first-line therapy for elderly patients with hypertension.
- These newer drug classes offer advantages in hemodynamic/biochemical profiles, dosing convenience, and quality of life maintenance.
Abstract:
Although earlier debates had questioned the wisdom of treating hypertension in elderly patients, it is now becoming apparent that such treatment is warranted. Systolic hypertension, which prevails in this population, is more closely correlated to hypertensive complications than is diastolic blood pressure. Recent multicenter trials have demonstrated that in this age group, as in younger patients, control of hypertension can significantly decrease the rate of cardiovascular and cerebrovascular events. Many effective antihypertensive agents are available today, but elderly patients, because of their hemodynamic and biochemical characteristics, are particularly vulnerable to the common side effects of most drugs. However, the two newer classes of drugs (the angiotensin-converting enzyme inhibitors and the calcium channel blockers) offer several advantages in terms of favorable hemodynamic and biochemical profiles, convenience of dosing, and maintenance of quality of life. These characteristics justify choosing these agents as first-line therapy for hypertension.