Tolerability of Antihypertensive Medications in Older Adults

Abstract

Several guidelines for hypertension have recently undergone revisions to incorporate an approach providing choices of medications based on age, race, and specific situations where hypertension may co-exist with disorders such as diabetes, coronary artery disease, heart failure and chronic kidney disease. Initial recommendations include diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers; beta blockers are favored in some guidelines and are a choice in specific settings. Within the classes of drugs, several antihypertensive agents provide options. This review discusses antihypertensive drugs by class, including adverse effects and tolerability, with preferences in older adults and specific settings. Adverse drug events from antihypertensive medications are discussed by class and where applicable for specific agents. Data from select studies pertinent to tolerability and adverse effects are presented in tables for several classes of drugs. The rationale for nonadherence to medication is reviewed, including the roles played by tolerability and adverse drug effects. Antihypertensive therapy in typical settings in older adults is discussed; they include hypertension in association with impaired cognition, depression, diabetes, sexual dysfunction, and falls. The key to successful therapy and tolerability is to promote a healthy lifestyle in conjunction with medications as the approach, thereby also lowering the adverse drug effects. The eventual choice of the specific drug(s) is based on risks, benefits, and patient preferences, and is best tailored for each older adult.

High fat diet confers vascular hyper-contractility against angiotensin II through upregulation of MLCK and CPI-17

“…Based on small controlled trials and clinical experiences angiotensin converting enzyme inhibitor, thiazides, calcium channel blockers, and statins turned to be useful in treating obesity-related hypertension [20]. However, these drugs draw adverse effects including tolerability [21], renal dysfunction [22], angina, arrhythmias, hypotension, arthritis, asthma etc. [23].…”

The role of beta-adrenolytic drugs in treating anxiety disorders

“…Using beta blockers in psychiatry involves a lot of controversy. There is certain evidence supporting the use of beta blockers in treating panic disorder and PTSD; however, it is not recommended to apply them in the treatment of other forms of anxiety [83]. It was demonstrated in a number of casuistic works that metoprolol can cause anxiety in elderly patients, which is relieved or subsides after the drug is discontinued [84].…”

“…Zastosowanie beta-blokerów w psychiatrii niesie ze sobą wiele kontrowersji. Istnieją pewne dowody popierające stosowanie beta-blokerów w leczeniu lęku panicznego oraz PTSD, jednak wdrażanie ich nie jest wskazane w leczeniu innych form lęku [83]. W kilku pracach kazuistycznych wykazano, że metoprolol może wywoływać lęk u pacjentów w podeszłym wieku, który łagodzi się lub ustępuje po odstawieniu leku [84].…”

Pharmacological Management of Anxiety Disorders in the Elderly

“…While there is evidence to support the use of beta-blockers to treat performance anxiety, their use is inot indicated to treat other forms of anxiety [74]. Several case studies have shown metoprolol may induce anxiety in elderly patients, which improves or resolves with discontinuation of the drug [75].…”