There is no age at which hypertension should not be treated, and there is no age at which it should be treated. Thiazide diuretics are the first-line treatment for isolated systolic hypertension, and they should be considered as part of any antihypertensive regimen in older people who have high blood pressure.
Antihypertensive medicines are widely accessible, with thiazide diuretics being the chosen first-line therapy for most people with hypertension. In this demographic, beta-blockers and alpha-blockers are typically not suggested due to their potential side effects. The vast majority of elderly people will take two or three antihypertensive drugs to achieve their blood pressure goals.
As a result, using a diuretic to manage hypertension in the elderly is a smart initial step, and a thiazide or thiazide-like diuretic is typically the most appropriate medication to use. Because of their sensitivity to diuretics, it is necessary to take extra precautions while treating older people.
If a patient has stage 1 HTN and has a 10-year ASCVD risk of 10% or greater, antihypertensive medicines should be initiated, with a target blood pressure of less than 130/80 in order to prevent cardiovascular events in the patient.
One of the most common adverse effects of ACE inhibitors is a dry cough, followed by hypotension. When using ACE inhibitors, it is possible to develop hyperkalemia. The administration of these medications in older patients with renal impairment should be done with great care and extreme caution, according to the manufacturer.
Beta-blockers are less successful in lowering blood pressure than diuretics, and they are also poorly tolerated in the elderly population.
When it comes to treating hypertension in the elderly and non-elderly, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and low-dose diuretics are all indicated as first-line treatments.
Additionally, ACE inhibitors have several ancillary characteristics that may be beneficial for many elderly patients, including a reduction in left ventricular mass, the absence of metabolic and lipid disturbances, the absence of adverse CNS effects and a low risk of induction of heart failure, as well as an increased risk of orthostatic hypotension.
Recent medical recommendations have indicated that thiazide-type diuretics be used as the preferable medicine for the treatment of elderly hypertension patients, followed by long-acting calcium antagonists, based on the available clinical data.
Overdose, underdosage, improper therapy, poor monitoring, nonadherence, and drug interactions are all prevalent drug-related difficulties in older persons. These problems include ineffectiveness of medications as well as unpleasant drug effects. (See also Overview of Drug Therapy in Older Adults for further information.)
In contrast, older patients are more prone to develop age-related liver, renal, or cardiac issues. As a result, individuals using atenolol should exercise caution and their dosage may need to be adjusted as a result.
There are several cardiac disorders that you should avoid taking metoprolol oral pills if you have. Sinus bradycardia, heart block, shock, some forms of heart failure, sick sinus syndrome, and significant issues with blood circulation are among the illnesses that might cause these symptoms. Metoprolol should not be used if any of the following conditions exist.
Because beta-blockers have an effect on the heart, you should avoid eating or drinking items that include caffeine, as well as consuming over-the-counter cough and cold medications, antihistamines, and antacids that contain aluminum while taking them. You should also avoid consuming alcohol because it has been shown to reduce the effectiveness of beta-blockers in certain people.
Regarding overall mortality, ramipril was related with the lowest mortality while lisinopril was connected with the greatest mortality. Enalapril was shown to be the most effective treatment for boosting ejection fraction and stroke volume, whereas the placebo was found to be the least effective.
Calcium channel blocker medications have been demonstrated to be useful in the management of hypertension in individuals of any age group, and they are also safe in the older population. These medications work by inhibiting L-type calcium channels, with the long-acting or newest generation dihydropyridines being the most effective of this class of medications.
There are various kinds of drugs available for the treatment of hypertension in the elderly, the most regularly prescribed of which are alpha-blockers, beta-blockers, calcium channel blockers (CCBs), diuretics, ACE inhibitors, and ARBs, as well as combination therapies.