Physiological changes due to age. Implications for drug therapy of congestive heart failure

The segment of the population considered to be 'elderly' is consistently growing. At the same time, the number of patients with congestive heart failure continues to grow. Therefore, it is important to consider whether older patients with congestive heart failure have characteristics that identify an aging effect in addition to the obvious abnormalities produced by heart failure. Furthermore, it is important to determine the relevance of these abnormalities to the use of pharmacological therapy. Within a population of 128 consecutive heart failure patients, age-related increases of systemic vascular resistance, changes in baroreceptor responses, and increases of plasma noradrenaline (norepinephrine) levels were identified. In addition, an age-related reduction of renal function was clearly evident in patients > 65 years of age. These changes affect the use of digoxin, diuretics and angiotensin converting enzyme (ACE) inhibitors. Most notably, marked reduction of renal function in such patients must be considered in the drug treatment of heart failure.