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Treatment of the elderly hypertensive: a clinical perspective

W H Birkenhäger1, P W de Leeuw

  • 1Zuiderziekenhuis, Department of Internal Medicine, Rotterdam, The Netherlands.

European Heart Journal
|March 1, 1988
PubMed

Insights

Antihypertensive treatment significantly benefits elderly individuals with high blood pressure, improving cardiovascular prognosis. Thiazide diuretics are recommended as the first-choice treatment for elderly hypertension based on trial results.

Area of Science:

  • Gerontology
  • Cardiology
  • Pharmacology

Background:

  • High blood pressure (hypertension) poses significant risks to elderly health and longevity.
  • Physicians often hesitate to treat hypertension in older adults due to concerns about cardiovascular homeostasis.
  • Recent trials indicate a positive benefit-to-risk ratio for antihypertensive therapy in the elderly.

Purpose of the Study:

  • To review evidence on the efficacy and safety of antihypertensive treatments in elderly patients.
  • To present findings from the European Working Party on Hypertension in the Elderly (EWPHE) trial.
  • To provide practice recommendations for managing hypertension in older adults.

Main Methods:

  • Review of controlled trials on antihypertensive treatment in elderly hypertensives.
  • Detailed analysis of the European Working Party on Hypertension in the Elderly (EWPHE) trial data.
  • Consideration of different classes of hypotensive drugs and their implications.

Main Results:

  • Multiple controlled trials demonstrate favorable outcomes for antihypertensive treatment in elderly individuals.
  • The EWPHE trial provides extensive data supporting treatment benefits.
  • Thiazides, with potassium-sparing agents, emerge as a recommended first-line therapy despite biochemical considerations.

Conclusions:

  • Antihypertensive treatment is beneficial for cardiovascular prognosis in elderly patients with hypertension.
  • Thiazides are recommended as the initial treatment of choice for elderly hypertension.
  • Further research is needed to clarify the roles of other drug classes like beta-blockers, calcium channel blockers, and ACE inhibitors.

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