Calcium antagonists in the treatment of hypertension and angina pectoris in the elderly.
Calcium antagonist drugs are widely used in the treatment of hypertension and ischemic heart disease in middle-aged and elderly patients. There are reports that both the pharmacokinetics and pharmacodynamics of these drugs may be affected by increasing age, but the clinical relevance of any age-related changes remains unclear. There is evidence of significant age-related differences in pharmacokinetics that mainly reflect reduced drug clearance in the elderly, leading to higher plasma drug levels. However, calcium antagonist drugs demonstrate wide intersubject variability in pharmacokinetics, particularly in the elderly, and this often obscures any age-related differences. Increased antihypertensive responsiveness has been reported in the elderly, but there is other evidence to suggest that this may not be an independent age-related effect. If allowance is made for differences in pretreatment blood pressure and plasma drug concentrations, there is no confirmatory evidence of an age-related preferential antihypertensive action. Similarly, there is no evidence that the elderly are more susceptible to the adverse pharmacological effects of calcium antagonist drugs. For example, studies of the cardiac conduction effects of verapamil have failed to show an increased effect in the elderly. In fact, young subjects appear to be more likely to develop significant prolongations of atrioventricular conduction. Thus, although there are age-related differences in the clinical pharmacology of calcium antagonist drugs, there is no evidence to suggest that this affords any specific additional beneficial or adverse impact on their therapeutic usefulness.
Elliott
H L
HL
University Department of Materia Medica, Stobhill General Hospital, Glasgow, Scotland.
D000368:Aged; D000375:Aging / Q000378:metabolism; D000787:Angina Pectoris / Q000188:drug therapy* / Q000378:metabolism; D002121:Calcium Channel Blockers / Q000493:pharmacokinetics / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000378:metabolism
D002121:Calcium Channel Blockers