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Antihypertensive treatment according to age, plasma renin and race
1Division of Cardiology, University Hospital, Basel.
Insights
This study suggests an age-oriented approach to hypertension treatment. Angiotensin converting enzyme inhibitors or beta-blockers are recommended for younger patients, while calcium antagonists are advised for older individuals, improving blood pressure control.
Area of Science:
- Cardiology
- Pharmacology
- Gerontology
Background:
- Blood pressure control is crucial for reducing cerebrovascular accidents and myocardial infarction.
- Essential hypertension involves cellular membrane and calcium homeostatic derangements.
- Cardiovascular regulation and peripheral vasoconstrictor forces change with age in hypertensive patients.
Purpose of the Study:
- To propose an alternative, age-oriented treatment strategy for essential hypertension.
- To identify optimal drug classes based on patient age, renin activity, and ethnicity.
- To minimize adverse effects while normalizing blood pressure.
Main Methods:
- Review of studies on cellular membrane and calcium homeostasis in hypertension.
- Analysis of age-dependent cardiovascular regulation and peripheral vasoconstriction.
- Development of a two-way drug selection scheme based on patient characteristics.
Main Results:
- An age-oriented drug selection strategy is proposed.
- Angiotensin converting enzyme inhibitors or beta-blockers for younger, high-renin patients.
- Calcium antagonists instead of diuretics for older, low-renin, or Black patients.
Conclusions:
- This age-oriented approach normalizes blood pressure in approximately 80% of essential hypertension patients.
- The strategy aims to reduce adverse effects associated with antihypertensive medications.
- Optimized drug combinations can be achieved for difficult-to-treat patients.
Abstract:
Recent large scale antihypertensive treatment trials emphasise the importance of blood pressure control in reducing both cerebrovascular accidents and myocardial infarction. Obviously therefore, the drug that best normalises blood pressure while producing the fewest adverse effects should be sought. On the basis of studies demonstrating cellular membrane and calcium homeostatic derangements and an age-dependent transition of overall cardiovascular regulation and peripheral vasoconstrictor forces during the course of essential hypertension, this review proposes an alternative treatment. Under this treatment scheme angiotensin converting enzyme inhibitors or beta-blockers should be used in younger patients and in those with high plasma renin activity, while calcium antagonists are used in place of diuretics in older low-renin or Black patients. Age-oriented 2-way drug selection enables a normalisation of blood pressure without untoward effects in about 80% of patients with essential hypertension and helps to optimise drug combinations in those patients who are difficult to treat.