Are calcium antagonists the best option in elderly hypertensives?
SUITABILITY OF CALCIUM ANTAGONISTS FOR THE ELDERLY: The efficacy and safety of calcium antagonists have been clearly demonstrated in elderly hypertensive patients. In a double-blind placebo-controlled study in 31 elderly hypertensives treated with nicardipine, we found no consistent electrocardiogram changes, nor in the heart rate, plasma levels of potassium, sodium or creatinine, or uric acid; nor did we find any postural hypotension. The mechanism of action of this class of drugs appears to be particularly appropriate in the treatment of elderly patients, in whom hypertension is characterized by an increase in peripheral resistance and a decrease in arterial compliance. Since vascular tone is ultimately controlled by the intracellular calcium concentration in smooth muscles, agents such as calcium inhibitors, which inhibit calcium influx and induce dilation of small and large arteries, are of particular interest. EXPERIMENTAL EVIDENCE: There is some experimental evidence in hypertensive rats and hypercholesterolaemic rabbits that calcium antagonists can provide some protection against atherosclerotic degeneration. However, the validity of extrapolating these findings to humans is still disputed. POSSIBLE CEREBRAL EFFECT: Calcium antagonists might also have a beneficial cerebral effect. The acute administration of these drugs has been shown to increase cerebral blood flow. Moreover, several studies have shown a protective action against cerebral ischaemia and this may be of particular importance in the very elderly.
Forette
F
F
Broca Hospital, Paris, France.
Bert
P
P
Rigaud
A S
AS
D000368:Aged; D001158:Arteries / Q000187:drug effects; D001921:Brain / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D004361:Drug Tolerance; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008875:Middle Aged
D002121:Calcium Channel Blockers