[Antihypertensive therapy in elderly patients]

Arterial blood pressure increases with age. Because of the rapidly increasing number of elderly people, hypertension is a common problem in general medicine. The benefits of antihypertensive treatment in the elderly is nowadays well documented and has also proven in recent studies. Total mortality, cerebrovascular and cardiovascular events could be reduced by treating elderly patients with hypertension. However, some special features of elderly people must be considered, i.e. the alterations of the vessel wall reactivity, of decreased blood flow, of receptor function, of gastric, liver and renal function. Therefore, an altered pharmacokinetics can lead to an enhancement of the duration and potency of antihypertensive drugs. Initially, monotherapy with low doses of the five first line drugs is recommended: beta-blockers, diuretics, calcium channel blockers, ACE-inhibitors and alpha-1-blockers. Individual concomitant diseases and risk factors determine the choice of the drug. Because of the circadian blood pressure rhythm in primary hypertension with the highest values in the morning antihypertensive drugs should be given as early as possible. Drugs with a 24-hour duration of action should be preferred. Blood pressure should be carefully lowered into the desired range over a period of several weeks and months. Target is to lower diastolic blood pressure below 90 mmHg and systolic blood pressure below 160 mmHg in patients with initial values above 180 mmHg. In patients with initial values between 160-180 mmHg blood pressure should be reduced by nearly 20 mmHg.