Veterans Administration Cooperative Study Group on hypertensive agents: effects of age on treatment results

Article Abstract:

Elderly patients are different from younger patients in a number of ways, including having higher systolic blood pressure and lower cardiac output, heart rate, stroke volume, and blood flow through the kidneys. Because of this, it was expected that antihypertensive drugs, designed to lower blood pressure, would affect the elderly in different ways. To test this, 1,396 patients were given hydrochlorothiazide, bendroflumethiazide (diuretics), propranolol, nadolol (beta blockers), or captopril (an angiotensin-converting enzyme inhibitor). Nadolol and captopril were also given in combination with diuretics. Only the diuretics seemed to have a greater antihypertensive effect among elderly patients than among younger patients. However, no drug was less effective with older patients than younger ones. Among Caucasian patients, older patients responded less to propranolol than younger patients, and the differences between black and Caucasian patients has already been described elsewhere. Thiazide diuretics have a greater effect on systolic blood pressure, especially among older patients. The effects of combining a diuretic with one of the other drugs produced an additive effect. The older patients tolerated the side effects as well as younger ones. Older patients may be particularly responsive to drugs that reduce cardiac output, including the thiazide diuretics, ganglion-blocking agents, and alpha and beta blockers, and these should be used with caution. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Age-related hypotensive effect of placebo and active treatment in patients older than 60 years

Article Abstract:

Researchers have often reported that certain antihypertensive agents, drugs designed to lower blood pressure, affect elderly more than younger patients. This study assigned 742 patients either to treatment with hydrochlorothiazide (a diuretic antihypertensive) or a placebo. When the treated group was analyzed alone, the results showed that the effects of the diuretic increased with age among elderly hypertensive patients. However, once the placebo group was analyzed, it became clear that a similar blood pressure lowering action occurred in both groups. It is not clear why there was a decrease in blood pressure with age in the placebo-treated group, but it may have been a result of higher blood pressure levels at entry. However, adjustment for blood pressure at entry failed to explain the change, which occurred in both systolic and diastolic pressure readings. If the study had been conducted without a placebo, as most heart studies are, the conclusions would have been wrong. Many studies have found an age-related increase in the effectiveness of antihypertensive therapies, including diuretics, calcium channel blockers, and ketanserin. These studies did not compare treatments with placebos, therefore they were unable to measure whether the age-related effects of treatment compared with placebo. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Blood pressure, Placebos

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Treatment of hypertension in the elderly: effects on blood pressure, heart rate, and physical fitness

Article Abstract:

The benefits of drug therapy to lower high blood pressure (hypertension) have been demonstrated, but the studies to date have concentrated on how well the drugs lower blood pressure, and have ignored the effects on the patient and on physical fitness. Thirty-six patients over 60 years old were treated either with drug therapy or a placebo for two months. The drugs used in the study were a beta blocker (metoprolol), an angiotensin-converting enzyme inhibitor (ACE; captopril), and a diuretic with a potassium-sparing agent (hydrochlorothiazide-amiloride). Physical fitness was measured by exercise endurance. After two months of treatment, all three drug therapies were seen to lower blood pressure. Beta blockers also slowed the heart rate, but this did not result in any dangerous events during the study. The incidence of side effects was lowest with captopril, and highest during the pretreatment period and with the placebo. During the dynamic bicycle exercise endurance test, completed by 29 of the patients, duration of exercise declined from the pretreatment period with use of metoprolol and the diuretic, and was also lower than for the placebo group. Captopril produced the best effects on exercise endurance, with more patients reaching the highest step of the test. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects

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