Treatment of hypertension in the elderly

Article Abstract:

The incidence of blood pressure elevated to greater than 140/90 (hypertension) in individuals over the age of 65 is approximately 63 percent. The condition affects more blacks and white women than white males. Many studies have associated hypertension with increased risk for cardiovascular disease and other medical conditions. Until recently, hypertension was thought to be a normal condition of aging, and therapy for this condition in the elderly was considered a health risk. However, this has changed, and now most elderly individuals with hypertension receive drug therapy. Before prescribing drugs for the condition, it is essential for clinicians to thoroughly examine the patient and fit the specific drug to the individual. Care must be taken to identify those patients who suffer from postural changes in blood pressure; it is essential to test blood pressure while the patient is supine and while the patient is standing. Similarly, it is important to rule out individuals with pseudohypertension, patients whose pressure measurement is not properly ascertained because of the hardened condition of their arteries (Pressure measurements are based on collapsing the arteries; hardened vessels fail to collapse). Overall, nonpharmacologic therapy should be tried first, such as exercise, restriction of sodium, and weight reduction in obese patients. If drug therapy is required, it is best to begin with a small dose and slowly reduce blood pressure over a period of months. The goal of therapy should be a blood pressure of 160/90mmHg. It is important to monitor the patient and to anticipate possible side effects of the medication. The major classes of antihypertensives are also discussed, including diuretics, beta-blockers, alpha-blockers, vasodilators, calcium channel blockers, and angiotensin-converting enzyme inhibitors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Demographic aspects, Diet therapy

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Alpha-blocker therapy of hypertension: an unfulfilled promise

Article Abstract:

Alpha-blocking agents have only about 4 percent of the market for antihypertensive drugs, which are designed to lower blood pressure. There are several reasons for this, including physicians' perceptions of this class of drugs, limited marketing efforts, and the high interest in two other classes of drugs, calcium channel blockers and angiotensin-converting enzyme inhibitors. Alpha blockers are vasodilators (drugs that relax blood vessels) and do not affect cardiac output. Prazosin was the only alpha blocker available for 10 years, until terazosin was introduced in 1987; doxazosin was added recently. Studies of all three drugs are reviewed, finding that the drugs are effective and well-tolerated. The most troublesome side effects are first-dose syncope (fainting) and hypotension (low blood pressure), which can be minimized by using the newer, slow-acting drugs. Other side effects are fatigue, headache, palpitations, and nausea. One of the major advantages of alpha blockers is that they lower cholesterol, especially low-density lipoprotein ('bad' cholesterol) and triglycerides, and raise high-density lipoprotein ('good' cholesterol). Studies have documented that abnormal enlargement of the left heart ventricle improves with the use of alpha blockers. These drugs may also help control diabetes and relieve the symptoms of benign prostatic hypertrophy (enlarged prostate). (Consumer Summary produced by Reliance Medical Information, Inc.)

Doxazosin, Adrenergic alpha blockers, Adrenergic alpha-antagonists, Prazosin, Terazosin hydrochloride, Terazosin

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Calcium entry blockers in the treatment of hypertension; current status and future prospects

Article Abstract:

Calcium entry blockers (CEBs) will see more use in treating high blood pressure. CEBs alter the electrical properties of the cells of the blood vessels so that the vessels dilate, lowering blood pressure. Current CEBs have similar effectiveness against hypertension but have different effects on the electrical system that triggers the heartbeat and on the blood vessels. New dihydropyridine CEBs concentrate more on dilating blood vessels, with fewer side effects on other muscle tissue, and may be more usable in patients with congestive heart failure. Effects are relatively age- and race-independent. Patients may require sodium-restricted diets or diuretics due to slightly excessive sodium secretion in the urine. Short-term CEB treatment preserves or improves kidney function, but its long-term effect is unknown. CEBs are not proven to protect against coronary heart disease heart muscle, but experiments have suggested continuing to search for such a protective effect. CEBs are important antihypertensives and newer versions may be more usable because of their more specific effects.

Cardiovascular diseases, Cardiovascular agents, Calcium channel blockers

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