Antiadrenergic therapy: special aspects in hypertension in the elderly

The effect of antiadrenergic treatment with methyldopa was studied in 17 patients with established essential hypertension who were subdivided with respect to age in a group younger (n = 10; mean age, 47 +/- 2.4 (SEM) years; and a group older than 60 years of age (n = 7, mean age, 67 +/- 2.8 SEM). The fall in arterial pressure was associated with a significant (p less than 0.05) decrease in cardiac output and heart rate in patients over 60 years of age and no change in total peripheral resistance, whereas a (nonsignificant) fall in resistance occurred in younger patients. In both age groups, a significant (p less than 0.05 and less than 0.01, respectively) decrease in plasma norepinephrine levels was observed, whereas epinephrine and dopamine showed no changes. Pre- and posttreatment values of mean arterial pressure correlated directly with plasma norepinephrine values (r = 0.35 p less than 0.05). Regardless of whether cardiac output was reduced or remained unchanged, renal blood flow, plasma and total blood volume did not change in either group with antiadrenergic treatment. Further, reflexive cardiac changes (responses to isometric exercise and upright tilt) remained qualitatively unchanged. It is concluded that antiadrenergic treatment with methyldopa lowers arterial pressure additionally by decreasing circulating norepinephrine levels. The antihypertensive effect is associated with a fall in peripheral resistance in the younger and a decrease in cardiac output in the older patients, and does not compromise renal blood flow or cardiac reflexive responses.