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Antihypertensive treatment with a dual-acting beta-blocker in the elderly
1Cardiopulmonary Department, SmithKline Beecham Pharmaceuticals, King of Prussia, Pennsylvania.
Insights
Antihypertensive treatment benefits elderly patients with hypertension, but comorbidities complicate care. Dual-acting drugs like carvedilol offer a new approach, managing blood pressure effectively without negatively impacting cardiac function.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Background:
- Elderly hypertensive patients often have coexisting conditions like myocardial ischemia, left ventricular hypertrophy, and impaired renal function.
- Metabolic abnormalities, including lipid and glucose metabolism disorders, are common in this population.
- Traditional antihypertensives may be unsuitable due to adverse metabolic or cardiac effects.
Purpose of the Study:
- To review risk factors and treatment considerations for hypertension in the elderly.
- To evaluate the role of different antihypertensive drug classes.
- To highlight the potential benefits of dual-acting agents, specifically carvedilol.
Main Methods:
- Review of clinical trials and pharmacological data on antihypertensive treatments in elderly patients.
- Analysis of the effects of various drug classes on cardiovascular and metabolic parameters.
- Examination of carvedilol's specific properties and clinical effects.
Main Results:
- Antihypertensive therapy significantly reduces cardiovascular events in the elderly.
- Newer agents like ACE inhibitors, calcium-channel blockers, and alpha-blockers are effective alternatives.
- Carvedilol, a dual-acting agent, demonstrates favorable hemodynamic effects and does not impair left ventricular systolic function.
Conclusions:
- Managing hypertension in the elderly requires careful consideration of comorbidities.
- Dual-acting beta-blockers, such as carvedilol, represent a promising therapeutic option.
- Carvedilol may improve cardiac function in select patients, including those with heart failure.
Abstract:
Risk factors in elderly hypertensives: Recent large-scale clinical trials have shown that antihypertensive treatment in the elderly produces meaningful reductions in strokes and other cardiovascular events. However, the treatment of hypertension in older patients is often complicated by the presence of concomitant disorders. Clinical and silent myocardial ischemia, as well as left ventricular hypertrophy and both systolic and diastolic left ventricular dysfunction, frequently coexist with hypertension. Additional clinical considerations in elderly hypertensives include a high prevalence of abnormal lipid and glucose metabolism and a tendency toward decreased renal function. Effects of different antihypertensive drugs: Although diuretics and conventional beta-blockers have been used as first-line drugs in the major clinical trials, some of their effects on metabolic parameters and on the myocardium can make them inappropriate in some patients. Newer drug classes, including angiotensin converting enzyme (ACE) inhibitors, calcium-channel blockers and, more recently, alpha 1-adrenergic blockers are effective alternatives. Dual-acting beta-blockers offer an important new approach for treating hypertension in elderly patients. Effects of carvedilol: Carvedilol possesses both beta- and alpha 1-blocking activity and appears to exhibit calcium channel blocking activity in animals. The alpha 1-blocking properties of this drug help to produce a desirable hemodynamic profile and facilitate appropriate blood pressure and heart rate responses to exercise. Carvedilol does not appear to adversely affect left ventricular systolic function and, in selected patients with heart failure, has been shown to increase the ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)