The art in managing the elderly hypertensive patient

Progressive aging of the World's population means that choosing the most effective drugs for the elderly is becoming increasingly important. The goal of antihypertensive therapy is to lower the blood pressure, as well as to maintain the quality of life of elderly patients and to reduce the overall cardiovascular risks. However, the choice of drug therapy in the elderly must consider alterations in patients physiology due to age, other medical illness, concomitant medications and ease of administration and thus must be individualized. Recent studies have proven diuretic treatment to be safe, effective and well tolerated by older hypertensive patients. It is best to start with a low dose. A potassium-sparing diuretics can be used but both hypokalemia and hyperkalemia have to be guarded against. Probably in the future, the calcium antagonists will become the preferred initial therapy in the elderly. They are certainly very useful drugs but are not without side-effects. The beta-blockers are useful in the elderly but they are not ideal for initial therapy. The initial dose should be small. The angiotensin converting enzyme inhibitors are also very valuable drugs but are best for those elderly hypertensives who have heart failure or those whose blood pressure is difficult to control. Alpha-adrenoceptor blockade is desirable but can cause problems with postural hypotension in the elderly.