Key result
Starting antihypertensive therapy with low dosages followed by a stepwise increase may lead to improved blood pressure control and fewer adverse drug reactions in elderly patients.
Why the study?
Guidelines recommend treating every elderly patient with hypertension, but little information is available on optimal antihypertensive dosages to treat elderly patients safely given altered pharmacokinetics and pharmacodynamics.
This review highlights the importance of pharmacokinetic and pharmacodynamic changes in elderly hypertensive patients and recommends starting with low doses of antihypertensive drugs followed by stepwise increases to improve control and minimize adverse events.
May support low-dose stepwise titration in elderly hypertension; leaves open confirmation in prospective trials.
INTRODUCTION: Hypertension is an important risk factor for developing cardiovascular diseases. It is more prevalent in the elderly population. Recently updated American and European guidelines recommend treating every elderly patient with hypertension independent of age, starting with a low dose of antihypertensive drugs. However, little information is available on the optimal dosages of antihypertensive drugs to treat the elderly safely. Areas covered: Comorbidities, co-medication and frailty status can alter the clinical outcome of drug treatment and can cause adverse events in the elderly. Also, due to pharmacokinetic and pharmacodynamic changes the interpatient variability when using antihypertensive drugs is considerable. In this review, an overview is given on the extent to which the previously mentioned parameters are changed in elderly patients and what this means for the exposure to antihypertensive medication. Also, recommendations on the starting dose of the most frequently used antihypertensive drugs are given based on literature data. Expert opinion: We believe that recommendations on starting dosages followed by a stepwise increase of dosages will lead to improved blood pressure control and less adverse drug reactions in the elderly patient. This may improve adherence to antihypertensive therapy.
No takes yet. Share an insight, caveat, or question.
Peeters et al. (2019) conducted a review in Hypertension. Antihypertensive drugs was evaluated. Starting antihypertensive therapy with low dosages followed by a stepwise increase may lead to improved blood pressure control and fewer adverse drug reactions in elderly patients.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: