Treatment of hypertension in the elderly--what have we learned from the recent trials?

Cardiovascular Drugs and Therapy
P Lund-Johansen

Abstract

Treatment of hypertension in the elderly has so far mainly been based on clinical judgment and very few large controlled trials. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP, and MRC trials. All have shown that drug treatment of hypertension in the elderly (65-85 years) with permanent diastolic hypertension or isolated systolic hypertension reduces stroke incidence. Most patients have needed combined drug treatment with diuretics and beta-blockers. When thiazide diuretics are used, serum potassium should be followed very closely and most likely amiloride should be added to the thiazide therapy, since this was done both in the STOP and the MRC trials. Since many elderly patients with hypertension suffer from other diseases that might represent contraindications to thiazide diuretics or beta-blockers, the choice of drug must be made after careful clinical evaluation. With the newer classes of antihypertensive agents (calcium antagonists, ACE inhibitors and alpha-blockers) side effects are probably seen less often, but long-term data on morbidity and mortality are still lacking.

References

Dec 1, 1992·Cardiovascular Drugs and Therapy·L H Opie
Feb 15, 1992·BMJ : British Medical Journal·K BeardS Webb
Jan 23, 1991·JAMA : the Journal of the American Medical Association·L FarnettM R Tuley
Dec 1, 1991·Cardiovascular Drugs and Therapy·J R Hampton
May 1, 1990·Journal of Hypertension·B LernfeltJ Wikstrand
Oct 5, 1988·The American Journal of Cardiology·T A Kotchen, G P Guthrie

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Citations

Jan 1, 1995·Archives of Gerontology and Geriatrics·E Ambrosioni, S Bacchelli
Aug 29, 2001·Women & Health·H V McCoy, A Wasserman
Oct 8, 2004·Journal of Drug Education·George S YacoubianRonald J Peters

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