ACE-INHIBITORS - DIFFERENTIAL USE IN ELDERLY PATIENTS WITH HYPERTENSION

High blood pressure (BP) in the elderly must not be ignored as a norma l consequence of aging. The criteria for the diagnosis of hypertension and the necessity to treat it are the same in elderly and younger pat ients. The aim of treatment of elderly hypertensive patients is to dec rease BP safely and to reduce; risk factors associated with cerebrovas cular, cardiovascular and renal morbidity and mortality. The treatment of elderly hypertensive patients should be adjusted according to the needs of the individual, based upon age, race, severity of hypertensio n, co-existing medical problems, other cardiovascular risk factors, ta rget-organ damage, risk-benefit considerations and costs. In addition to the elevated BP, other cardiovascular risk factors include smoking, glucose intolerance, hyperinsulinaemia, dyslipidaemia, hypercreatinin aemia, peripheral vascular disease, left Ventricular hypertrophy, and microalbuminuria (or albuminuria). Thus, the choice of initial antihyp ertensive therapy in elderly hypertensive patients should be based not only on the expected response, but also on the effects of therapy on lipid, potassium, glucose and uric acid levels, and left ventricular a natomy and function. Go-existing medical conditions (such as asthma, d iabetes mellitus, heart failure, renal failure, gout, coronary artery disease, hyperlipidaemia and peripheral vascular disease) are major de terminants for the selection of antihypertensive medications. With pre vious therapies (diuretics, beta-blockers, etc.), good BP control in t he elderly was associated with clear and statistically significant red uctions in stroke-related morbidity and mortality, but the overall eff ects on cardiovascular and renal complications of hypertension was eit her more variable or less obvious. Angiotensin converting enzyme (ACE) inhibitors are not only efficacious antihypertensive agents in the el derly, but also appear promising in counteracting some of the cardiova scular and renal consequences of hypertension. They are well tolerated and have a relatively low incidence of adverse effects. ACE inhibitor s possess ancillary characteristics that are potentially beneficial fo r many elderly patients, including reduction of left ventricular mass, lack of metabolic and lipid disturbances, no adverse CNS effects, no risk of induction of heart failure, and a low risk of orthoscatic hypo tension. Since ACE inhibitors may improve perfusion to the heart, kidn ey and brain, they are well worth considering for the treatment of eld erly patients with hypertensive target organ damage, especially in pat ients with heart failure, and diabetic patients with early nephropathy .