The Growing Role of Calcium Antagonists in Treating Hypertension in the Elderly

Increasing attention has focused on the magnitude of hypertension in the elderly, with recent data indicating that it afflicts over 50% of people greater than 65 years of age. Recent studies have clearly demonstrated that treatment of isolated systolic and diastolic hypertension in older patients confers substantive protection against hypertension induced morbidity and mortality, to an extent greater than previously appreciated. The results of the recent Systolic Hypertension in Europe (Syst-Eur) trial have demonstrated a striking decrease in the occurrence of strokes, as well as heart failure and all cardiac events in the active treatment group. Because a long acting dihydropyridine calcium antagonist was used in the Syst-Eur trial, it is reasonable and appropriate to recommend a long acting calcium antagonist as one of the preferred agents in the management of isolated systolic hypertensive (ISH) patients. Recent attention has also focused on the importance of formulation and pharmacokinetics as a determinant of cardiovascular risk. It is clear that the newer slow release formulations and intrinsically long acting calcium antagonists are to be preferred. By virtue of their ability to attain more gradual and sustained plasma levels, they do not evoke reactive sympathetic activation. Concomitantly, such formulations should promote increased patient compliance and thereby favorably influence hypertension related morbidity and mortality.