OPTIMIZING DIURETIC THERAPY IN ELDERLY PATIENTS WITH HYPERTENSION

Hypertension is the most important risk factor for cardiovascular even ts in the elderly and it is present in more than 50% of-acculturated p opulations over 60 years of age, Morbidity trials have clearly demonst rated the benefits of treating hypertension in the elderly in all subg roups examined, including diabetics, those over 80 years of age, those with or without electrocardiographic abnormalities, and in both men a nd women. These reductions in strokes, coronary events, and other hype rtensive complications have been seen primarily with diuretic-based re gimens, with or without potassium-sparing therapy. However, in the 199 0s physicians are initiating diuretics less often for older patients w ith hypertension in spite of this scientific evidence. Low doses of di uretics have been well tolerated, successful in recent morbidity trial s, and avoid much of the concerns about theoretical toxicities from di uretics, although higher doses have also been shown to reduce cardiova scular events. Until calcium channel blockers, angiotensin converting enzyme inhibitors, alpha-blockers, or some other class of antihyperten sive agent has been demonstrated to be at least as effective as diuret ics in reducing cardiovascular events or mortality, diuretics should b e the first drug class to consider for the treatment of hypertension i n the elderly.