CALCIUM-ANTAGONISTS IN THE ELDERLY

The calcium antagonists are associated with a number of advantages ove r other antihypertensive agents, such as a lack of metabolic, vascular and respiratory adverse events, yet are effective in reducing blood p ressure. The currently available calcium antagonists are widely used, and new members, particularly of the dihydropyridine group, continue t o emerge. These agents may well be considered for use in the managemen t of hypertension and angina in elderly people. They undergo significa nt first-pass metabolism and tend to have high values of hepatic clear ance with minimal amounts of unchanged drug in the urine. Plasma conce ntrations tend to be higher in elderly people and for that reason it m ay be prudent to initiate therapy with lower dosages. With this caveat , adverse effect profiles seem to be qualitatively and quantitatively similar in younger and older people. At equivalent plasma concentratio ns, the antihypertensive effect appears similar in young and elderly p atients, and clinical studies point to comparable efficacy with other drug classes. Calcium antagonists do not have adverse renal, respirato ry, cardiovascular, metabolic or peripheral vascular effects and there fore may be useful in patients with relevant concomitant disease.