Hypertension in the elderly and calcium antagonists

Journal of Clinical and Basic Cardiology 1999; 2 (2): 167-168

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Keywords: alter Mensch,  Hypertonie,  Kalziumantagonist,  calcium antagonist,  elderly,  hypertension

Safety concerns have largely focused around observational studies. One such study, that of Pahor is of better design than several of the others and highlights the dangers of inappropriate use of nifedipine capsules in the very elderly especially if there is only borderline hypertension. Emergency BP reduction is seldom required, especially not in the elderly. Such patients need to be examined and individually assessed. Chronic therapy of systolic hypertension in the elderly can be by either initial diuretic as in the SHEP study, or by initial calcium antagonist, as in the SystEur study. Long or medium acting preparations of calcium antagonists are preferred. From the point of view of cost-effectiveness, diuretics are cheaper than calcium antagonists and probably easier to manage. In the middle aged, there are few or no outcome studies with calcium antagonists, and only a few with beta-blockers. When diuretics do not work, or can not be expected to work, combination of a diuretic with a beta-blocker or an ACE inhibitor or switching to calcium antagonist-based therapy may safely be considered. J Clin Basic Cardiol 1999; 2: 167-8.