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[Arterial hypertension in the elderly. Is there still room for diuretics?]
Insights
Diuretics remain crucial for treating hypertension (HTA) in elderly patients, offering well-documented long-term effects despite some controversy. Low-dose diuretics are recommended for managing HTA and reducing cardiovascular risks in older adults.
Area of Science:
- Gerontology
- Cardiology
- Pharmacology
Context:
- Hypertension (HTA) is a significant risk factor for cardiovascular morbidity and mortality in the elderly.
- Recent literature has raised questions regarding metabolic disturbances, such as hypokalemia, associated with diuretic use.
- Despite controversies, diuretics are essential antihypertensive agents.
Purpose:
- To review the established role of diuretics in managing hypertension in elderly patients.
- To discuss the mechanisms of action and side effects of diuretics.
- To provide guidelines for the appropriate use of diuretics in older adults.
Summary:
- Diuretics, particularly at low doses, possess the most extensive long-term evidence among antihypertensive drugs.
- Their efficacy in managing hypertension and associated cardiovascular risks in the elderly is well-established.
- The article details diuretic mechanisms, side effects, and offers practical usage recommendations for the geriatric population.
Impact:
- Reinforces the importance of diuretics in elderly hypertension management.
- Provides evidence-based guidance for clinicians treating HTA in older patients.
- Contributes to understanding the risk-benefit profile of diuretics in a vulnerable population.
Abstract:
Hypertension (HTA), whether systolic and diastolic or as isolated systolic hypertension, has been firmly established as a major risk factor of morbidity and cardiovascular mortality in elderly patients. Despite recent controversies that have appeared in the literature on the metabolic disturbances caused by diuretics, especially hypokalemia, and the absence of a significant advantage on coronary mortality, these drugs should nevertheless be considered as extremely important in the treatment of HTA. Prescribed at small doses, their long-term effects are by far the best documented of all antihypertensive drugs. Their mechanisms as well as their main side effects are described below. Finally, the authors give some simple guidelines on their use, more specifically in elderly patients.