Related Experiment Videos
Managing the older patient with hypertension
1Department of Preventive Medicine, University of Tennessee, Memphis 38163.
Insights
Treating high systolic blood pressure in older adults significantly lowers stroke and heart risks. Effective treatments include diuretics and calcium antagonists, which are well-tolerated by elderly patients.
Area of Science:
- Gerontology
- Cardiovascular Medicine
- Pharmacology
Background:
- Elevated systolic blood pressure (SBP) poses a greater cardiovascular risk in elderly individuals compared to diastolic blood pressure.
- Several major clinical trials have investigated the efficacy of antihypertensive therapies specifically in the elderly population.
Purpose of the Study:
- To synthesize findings from major antihypertensive trials in the elderly.
- To identify effective drug classes for managing hypertension in older adults.
- To assess the impact of blood pressure reduction on morbidity and mortality in this demographic.
Main Methods:
- Review and analysis of results from key clinical trials: Systolic Hypertension in the Elderly Program (SHEP), Swedish Trial in Older Patients with Hypertension (STOP-Hypertension), Medical Research Council (MRC) Trial, and Veterans Affairs Cooperative Study Group (VA-CGS).
- Evaluation of specific antihypertensive drug classes for efficacy and tolerability in elderly patients.
Main Results:
- Blood pressure reduction in elderly patients demonstrably decreases morbidity and mortality associated with stroke and cardiac disease.
- Diuretics and calcium antagonists show particular efficacy in treating hypertension in the elderly.
- Beta-adrenergic blockers and angiotensin-converting enzyme inhibitors may be less suitable for this patient group.
Conclusions:
- Antihypertensive therapy is beneficial for reducing cardiovascular events and improving survival in elderly individuals with elevated systolic blood pressure.
- Diuretics and calcium antagonists are recommended as first-line agents for elderly hypertensive patients.
- Elderly patients can generally tolerate effective doses of antihypertensive medications without compromising quality of life.
Abstract:
In elderly patients, elevation of systolic blood pressure represents a more serious risk than elevation of diastolic blood pressure. Major trials of antihypertensive therapy in the elderly include the Systolic Hypertension in the Elderly Program, the Swedish Trial of Older Patients with Hypertension, the Medical Research Council Trial, and the Veterans Affairs Cooperative Study Group. Results of these trails indicate that, even for very elderly patients, reducing blood pressure reduces both morbidity and mortality from stroke and cardiac disease. Diuretics and calcium antagonists stand out as particularly efficacious in elderly hypertensive patients. beta-Adrenergic blockers and angiotensin converting enzyme inhibitors may be less suitable in this patient population. Studies of the effects of antihypertensive therapy on the quality of life indicate that elderly patients can easily tolerate efficacious doses of antihypertensive drugs.