Elderly hypertension

Hearing SD, Wesnes KA, Bowman CE. Beta blockers and cognitive function in elderly hypertensive patients withdrawal and consequences of ACE inhibitor substitution. Int J Geriatr Psychopharmacol 1999 2 13-7. 

Abernethy DR, Schwartz JB, Todd EL, Luchi R, Snow E. Verapamil pharmacodynamics and disposition in young versus elderly hypertensive patients. Ann Int Med 1986 105 329-36. 

Verza M, Cacciapuoti F, Spiezia R, D Avino M, Arpino G, D Errico S, Sepe J, Varricchio M. Effects of the angiotensin converting enzyme inhibitor enalapril compared with diuretic therapy in elderly hypertensive patients. J Hyper tens 1988 6(suppl 1) S97-S99. 

A series of trials in elderly hypertensive subjects has shown a very pronounced reduction in cardiac events as a result of treatment based on thiazide diuretics. In the European Working Party on Hypertension in the Elderly (EWPHE) trial (13), total cardiovascular deaths were reduced by 38%, all cardiac deaths by 43%, and deaths due to myocardial infarction by 60%. Benefits in the Systolic Hypertension in the Elderly Program (SHEP) included a reduction in fatal and non-fatal myocardial infarction of 25% and major cardiovascular events of 32% (14) and were seen in those with and without electrocardiographic abnormalities at entry. The risk of heart failure was also reduced in patients taking chlortalidone-based therapy (15). Relative risk was similar in patients with and without non-insulin dependent diabetes meUitus absolute risk reduction was twice as great in the diabetic subjects (16). The Swedish Trial of Old Patients with Hypertension (STOP-Hypertension) reported a significant reduction in myocardial infarction and all-cause mortahty (17). In the MRC Trial in elderly adults (18), diuretic treatment reduced coronary events by 44% and fatal cardiovascular events by 35%. 

It has been argued that potassium-sparing diuretics present a real risk of renal insufficiency when they are used in elderly people (15). In large-scale studies in elderly hypertensive patients there is indeed some slight increase in the incidence of renal insufficiency when combinations including potassium-sparing diuretics are used. Although the overall incidence of nephrotoxicity is quite low, elderly patients and those with prior renal dysfunction are at particular risk. Special care is necessary in these circumstances. 

Sharabi Y, Ilian R, Kamari Y, Cohen H, Nadler M, Messerli FH, Grossman E. Diuretic induced hyponatraemia in elderly hypertensive women. J Hum Hypertens 2002 16(9) 631-5. 

In the 6-week comparative study of rofecoxib and celecoxib in elderly hypertensive patients with OA, 4 patients (1.0%) in the rofecoxib group and none in the celecoxib group developed CHF during the study [128]. 

With few exceptions, DHF caimot be distingnished from SHF on the basis of the history, physical examination, chest x-ray, and electrocardiogram (ECG) alone. The freqnency with which patients have symptoms of HF and signs of HF on physical examination or chest x-ray is not dependent on whether they have SHF or DHF. Patients with DHF are often elderly, hypertensive females. In one study, patients with DHF had a higher prevalence of hypertension with higher systolic, diastolic, and pnlse pressnres when compared with control patients and patients with SHF. °... 

Jolobe OM. Diuretic-induced hyponatraemia in elderly hypertensive women. J Hum Hypertens 2003 17 151. 

In the recent 8000-patient celecoxib long-term arthritis safety study [123], significantly more patients receiving traditional NSAlDs (ibuprofen or diclofenac) experienced clinically significant elevations in serum creatinine and/or serum urea nitrogen levels when compared to celecoxib. In an equally large gastrointestinal safety trial with rofecoxib, the incidence of adverse effects related to renal function for rofecoxib was similar to naproxen (1.2% versus 0.9%, respectively) [124]. When rofecoxib and celecoxib were directly evaluated in elderly hypertensive OA patients who manifested "normal" serum creatinine at the time of study recruitment, the overall incidence of clinically... 

In elderly hypertensive patients with normal renal function, half-life Is variable (7-15 hours). 

The disposition of sotalol appear to be comparable between obese individuals and control subjects (37). In elderly hypertensive subjects, however, renal clearance was reduced from a value of 4.10 0.60 ml/min/kg which was observed in healthy young subjects, to 1.93 0.32 ml/min/kg (32). Presumably, the reduction in sotalol renal clearance in the elderly is a reflection of the changed physiology in the elderly (e.g., reduced glomerular filtration). 

Ishizaki T, Hirayama H, Tawara K, Nakaya H, Sato M, Sato K Pharmacokinetics and pharmacodynamics in young normal and elderly hypertensive subjects A study using sotalol as a model drug. J. Pharmacol. Exp. Ther. 1980 212 173-181. 

Takeuchi K, Abe K, Yasujima M, Sato M, Tanno M, Sato K, YoidtinagaK. No adverse effect of non-steroidal anti-inflammatory drugs, sulindac and diclofenac sodium, on blood pressure control with a calcium antagonist, nifedipine, in elderly hypertensive patients. TchokuJExp Med (1991) 165, 201-Z... 

R, p-c, s-bld, paraller 8 30 Asian elderly hypertensive patients 1.1 1.5 Lactobacillus, Saccha- romyces helveticus Saccharomyces cerevisiae 1X 95 ml milk drink -14.1 -6.9 Hata et al. (1996)... 

Harris, T., Cook, E., Kannel, W., Schatzkin, A., Goldman, L. (1985). Blood pressure experience and risk of cardiovascular disease in the elderly. Hypertension, 7, 118-124. 

E. Bonacd, N. Santacroce, N. D Amico, and R. Mattace., Nail-fold capillaroscopy in the study of microcirculation in elderly hypertensive patients. Arch. Gerontol. Geriatr. suppl. 5, 79-83 (1996). 

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