title: Effectiveness and safety of dual renin-angiotensin system blockade: a comparison between younger and older cohorts.
abstract: OBJECTIVE
  The purpose of this review was to evaluate blood pressure (BP) reductions and adverse events between patients younger than 65 and older than 65 years of age receiving a combination of an angiotensin converting enzyme inhibitor (ACE-I) and an angiotensin receptor blocker (ARB).
  
  
  METHODS
  A retrospective cohort study comparing the effectiveness of ACE-I and ARB combination in patients < 65 (younger) and ≥ 65 years of age (elderly).
  
  
  METHODS
  This study was conducted at the VA Western New York Healthcare System.
  
  
  METHODS
  A total of 176 patients: 54 patients in the younger group and 122 in the elderly cohort.
  
  
  METHODS
  No specific interventions were performed.
  
  
  METHODS
  The purpose was to evaluate differences in BP reductions and incidence of adverse events in younger and elderly patients receiving a combination of an ACE-I and an ARB.
  
  
  RESULTS
  In the elderly group (mean age 76), the mean reduction in standing blood pressure (SBP) was 14.2 ± 15.6 mmHg (95% confidence interval [CI] 11.2-17.3; P < 0.0001). Similar results were obtained in the younger group (mean age 59), with a mean SBP reduction of 10 ± 14.9 (95% CI 5.6-14.5; P < 0.0001). The mean SBP reduction was not significantly different between the two age cohorts (P = 0.57). The incidence of adverse events was not different between the two age groups (cough P = 0.67, hyperkalemia P = 1.0, angioedema P = 0.31).
  
  
  CONCLUSIONS
  There was no significant difference in effectiveness or safety between the elderly and younger cohorts. The pharmacist monitoring elderly patients on combination therapy should still closely follow these patients; however it is reassuring that elderly patients do not experience adverse reactions at rates higher than do younger patients.
authors.affiliation: Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA.
authors.forename: Shah
authors.initials: S
authors.lastname: Urshila
authors.forename: Kari A
authors.initials: KA
authors.lastname: Mergenhagen
authors.forename: Kenneth
authors.initials: K
authors.lastname: Kellick
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D015331:Cohort Studies; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008875:Middle Aged; D009518:New York; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents