Treatment guideline in the USA: hypertension in the elderly

According to the JNC-5, at least six classes of antihypertensive agents have been synthesized and currently recommended for initial antihypertensive therapy in the USA for elderly patients. Each class is safe and effective in reducing arterial pressure, each has its own specific mechanism(s) of action that suppress specific pressor mechanisms, and each has its own side-effects which may be overcome by substituting a drug from another class of agents. In the case of adrenergic inhibitors, more specific agents have been introduced over the years. Each succeeding new class has obviated certain adverse effects of an earlier class. In the case of alpha-adrenergic receptor inhibitors, this concept is of particular value with the alpha 1A-receptor inhibiting compounds. The alpha 1-adrenergic inhibitors have special value for elderly patients with BPH as both hypertension and the prostatic disease can be treated with one compound. The alpha 1A-antagonists may have particular value in those patients in whom further reduction of arterial pressure is not desired and this obviously includes the normotensive elderly patient and the hypertensive patient whose blood pressure is already well-controlled by other agents.