Treatment of the elderly hypertensive: a clinical perspective.
The negative effects of high blood pressure on longevity and health in the elderly are considerable. Despite this fact physicians still tend to be reluctant when it comes to exposing elderly hypertensives to antihypertensive treatment. To some extent this cautious attitude can be rationalized because cardiovascular homeostasis becomes less effective with increasing age, particularly in hypertension. Over the past decade, however, several controlled trials have demonstrated a favourable benefit/hazard ratio with respect to the effects of antihypertensive treatment on cardiovascular prognosis in elderly hypertensives. The results of these trials are briefly reviewed, followed by a more extensive report on the trial conducted by the European Working Party on Hypertension in the Elderly (EWPHE). The implications for practice are considered with respect to different classes of hypotensive drugs. Thiazides--with potassium sparing adjuvants--despite their biochemically untoward effects are recommended as the treatment of first choice in view of the trial results. The remainder (beta-blockers, calcium channel blockers, ACE inhibitors, ketanserin) are still in the competing stage, although there may be clarification in the near future in terms of subjective side-effects and ancillary properties.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007650:Ketanserin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D007650:Ketanserin