Calcium antagonists in the elderly

The calcium antagonists are associated with a number of advantages over other antihypertensive agents, such as a lack of metabolic, vascular and respiratory adverse events, yet are effective in reducing blood pressure. The currently available calcium antagonists are widely used, and new members, particularly of the dihydropyridine group, continue to emerge. These agents may well be considered for use in the management of hypertension and angina in elderly people. They undergo significant first-pass metabolism and tend to have high values of hepatic clearance with minimal amounts of unchanged drug in the urine. Plasma concentrations tend to be higher in elderly people and for that reason it may be prudent to initiate therapy with lower dosages. With this caveat, adverse effect profiles seem to be qualitatively and quantitatively similar in younger and older people. At equivalent plasma concentrations, the antihypertensive effect appears similar in young and elderly patients, and clinical studies point to comparable efficacy with other drug classes. Calcium antagonists do not have adverse renal, respiratory, cardiovascular, metabolic or peripheral vascular effects and therefore may be useful in patients with relevant concomitant disease.