title: Tolerability of Antihypertensive Medications in Older Adults.
abstract: Several guidelines for hypertension have recently undergone revisions to incorporate an approach providing choices of medications based on age, race, and specific situations where hypertension may co-exist with disorders such as diabetes, coronary artery disease, heart failure and chronic kidney disease. Initial recommendations include diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers; beta blockers are favored in some guidelines and are a choice in specific settings. Within the classes of drugs, several antihypertensive agents provide options. This review discusses antihypertensive drugs by class, including adverse effects and tolerability, with preferences in older adults and specific settings. Adverse drug events from antihypertensive medications are discussed by class and where applicable for specific agents. Data from select studies pertinent to tolerability and adverse effects are presented in tables for several classes of drugs. The rationale for nonadherence to medication is reviewed, including the roles played by tolerability and adverse drug effects. Antihypertensive therapy in typical settings in older adults is discussed; they include hypertension in association with impaired cognition, depression, diabetes, sexual dysfunction, and falls. The key to successful therapy and tolerability is to promote a healthy lifestyle in conjunction with medications as the approach, thereby also lowering the adverse drug effects. The eventual choice of the specific drug(s) is based on risks, benefits, and patient preferences, and is best tailored for each older adult.
authors.affiliation: Department of Medicine, Montefiore Medical Center (Wakefield Campus), 600 East 233rd Street, Bronx, NY, 10466, USA. dharmarajants@yahoo.com.|Division of Geriatrics, Montefiore Medical Center (Wakefield Campus), Bronx, NY, USA. dharmarajants@yahoo.com.|Albert Einstein College of Medicine, Bronx, NY, USA. dharmarajants@yahoo.com.|New York Medical College, Valhalla, NY, USA. dharmarajants@yahoo.com.
authors.forename: Thiruvinvamalai S
authors.initials: TS
authors.lastname: Dharmarajan
authors.affiliation: Division of Cardiology, Lincoln Medical and Mental Health Center, Bronx, NY, USA.|Weill Medical College of Cornell University, New York, NY, USA.
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Dharmarajan
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000473:pathology / Q000502:physiology; D000959:Antihypertensive Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004232:Diuretics / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D055118:Medication Adherence; D019338:Polypharmacy; D017410:Practice Guidelines as Topic
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics