Which antihypertensive treatments are recommended in older adults?

Updated: Feb 22, 2019
  • Author: Matthew R Alexander, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Despite low plasma renin activity (PRA), blood pressure responds well to angiotensin-converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) therapy. Low doses of diuretics may also be effective. Thiazide-type diuretics may be particularly beneficial for patients aged 55 years or older with hypertension or CVD risk factors and for patients aged 60 years or older with isolated systolic hypertension. [7]  The SHEP trial found that chlorthalidone stepped-care therapy for 4.5 years was associated with a longer life expectancy at 22-year follow-up in patients with isolated systolic hypertension. [103]  The Syst-Eur trial used a study design and sample size similar to those of the SHEP trial, in which treatment with the CCB nitrendipine resulted in significant reduction in stroke and overall CVD events. [104]

Calcium antagonists are quite useful because of their strong antihypertensive effects. Often, combining 2 drugs at a lower dose may be preferable to using a single drug at a high dose, because of the potential for adverse effects with the higher dose. Beta-blockers may not be as effective as other first-line agents in patients aged 60 years and older, especially for stroke prevention, and should probably be used when other indications are present, such as heart failure, previous myocardial infarction, and angina. [7]

Elderly patients should also be encouraged to lose weight if necessary, be more physically active, reduce their salt intake, and avoid excessive alcohol intake. [5]


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