Present and Prospective Clinical Therapeutic Options for the Elderly Patient with Hypertension

Purpose The purpose of this review was to summarize current treatment guidelines and recently published studies about the efficacy and safety of antihypertensive therapy in elderly patients. Methods A literature research (MEDLINE) was performed with respect to the prevalence of hypertension in the elderly, the underlying pathophysiological mechanisms and current treatment options. Results Hypertension affects up to 70% of the population aged 65 years and older and results in a significant increase of cardiovascular morbidity and mortality. Antihypertensive drug therapy reduces the risk of cardiovascular complication and end organ damage not only in younger, but also in elderly patients. The most frequently applied classes of antihypertensive medication are diuretics, beta-blockers, ACE-inhibitors, angiotensin II-AT1-receptor blockers, calcium channel blockers, alpha-adrenergic receptor antagonists, centrally acting drugs and vasodilators. Side effects of antihypertensive medication have to be considered especially in the vulnerable elderly patients. The recently published HYVET study added important information on the value of antihypertensive therapy in patients at an age of 80 years or older. In the treatment group with indapamide and periondopril (compared to the placebo group) the risk of stroke was reduced by 30%, all-cause mortality by 21% and cardiovascular mortality by 23%. Conclusion Co-morbidities and age related changes of pharmacokinetics and pharmacodynamics require a very distinct choice of therapy in elderly people. Individual drug classes might be of advantage in certain conditions, including diabetes mellitus, renal dysfunction, heart failure and stroke.