Special considerations in the elderly patient.
Special considerations in the treatment of the elderly hypertensive include altered pathophysiology, the increasing likelihood of coexisting disease, and the question of whether reduction of left ventricular (LV) mass should be a therapeutic goal. The objective of our study was to compare the ability of a calcium blocker, verapamil, and a beta-blocker, atenolol, to induce reduction of LV mass and to determine the effects of any such reduction on LV filling and contractile performance. Forty-two hypertensive patients over 60 years of age were randomized to progressively increasing doses of long-acting verapamil or atenolol in a double-blind fashion and followed over a six-month period. Blood pressure decreased in both groups but atenolol-treated subjects more frequently required the addition of chlorthalidone. Despite similar blood pressure reductions, mean LV mass index, determined by two-dimensional echocardiography, was significantly reduced in the verapamil group magnitude of [104 +/- 5 g/m2 to 85 +/- 5 g/m2 (P less than 0.01)] but was not changed in the atenolol group. Following withdrawal of therapy, gated blood pool scan determined peak filling rate and the ratio of peak filling to peak ejection significantly increased in the group evidencing reduction (2.42 +/- 0.2 to 3.31 +/- 0.4 EDV/sec and 0.61 +/- 0.03 to 0.85 +/- 0.05, respectively) but did not change in the group which showed no reduction. Cardiac output and ejection fraction were maintained, both at rest and during mild upright exercise in the group evidencing reduction. Reduction of LV mass occurs more frequently with verapamil than with atenolol therapy in elderly hypertensives. Reduction improves diastolic filling and does not impair contractile performance.
Gerstenblith
G
G
Johns Hopkins Hospital, Baltimore, Maryland 21205.
D000367:Age Factors; D000368:Aged; D000375:Aging / Q000502:physiology; D001262:Atenolol / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D006332:Cardiomegaly / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D002752:Chlorthalidone / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D012307:Risk Factors; D014700:Verapamil / Q000494:pharmacology / Q000627:therapeutic use*
D001262:Atenolol; D014700:Verapamil; D002752:Chlorthalidone