Antihypertensive Therapy in Patients Above Age 60 with Systolic Hypertension

Abstract

1. Although systolic blood pressure elevation is responsible for increased incidence of cardiovascular accidents in old people, the preventive benefit of lowering systolic hypertension in elderly has not been confirmed. 2. A double blind study comparing the effects of a placebo and of an active regimen (hydrochlorothiazide-triamterene with or without methyldopa) in people over 60 years with isolated systolic hypertension has been undertaken by the European Working Party on High blood pressure in the Elderly (EWPHE). 3. The actively treated group shows a lowered sitting blood pressure (-15/6 mm Hg), a mild increase of serum creatine, serum uric acid and blood glucose and a mild decrease of serum potassium after two years of treatment when compared to the spontaneous changes observed in the placebo treated group. 4. The study is continuing to evaluate if the blood pressure reduction prevents or reduces the incidence of cardiovascular accidents, although some biochemical changes were provoked by the treatment.

Effect of nicardipine in elderly hypertensive patients.

“…At present, diuretics are generally used as first-line treatment (Amery et al, 1978), and their safety is satisfactory when adequate clinical and laboratory monitoring are done at regular intervals (Forette et al, 1982b). However, such monitoring is constraining to the patient and may lead to inadequate compliance, which in turn can give rise to serious complications (Editorial, 1978).…”

Isolated systolic hypertension and its relationship to the risk of myocardial infarction, cerebrovascular disease and death in a middle-aged population

“…Isolated systolic hypertension can be reduced effectively by the usual antihypertensive drugs as shown by Amery and co-workers! 26 ). In that study it was also found that contrary to general belief, isolated systolic hypertension may be more sensitive to antihypertensive therapy than hypertension with both high systolic and diastolic values.…”

Clinical pharmacology and the elderly patient

“…Of course inappropriate treatment can cause serious complications 130 treatment of mild and moderate hypertension is in progress but it will be some time before definitive results are available. It has been demonstrated in a preliminary report from this group that blood pressure can be significantly reduced with drug treatment 132 . The expected unwanted effects of thiazides in this age group are seenglucose intolerance 133 and raised serum urate and creatinine 132 -but an overall significant reduction of blood pressure is possible with acceptable levels of unwanted effects.…”