beta-blockers as first-line therapy for hypertension in the elderly

The efficacy and safety of the calcium channel blockers (CCBs) and beta-blo ckers were the focus of this presentation. The CCB class of antihypertensiv es comprises a heterogeneous group of agents. Safety concerns over their us e in patients with hypertension arose because of inappropriate and unapprov ed use of short-acting CCBs. It has been known for some time that nifedipin e, when used to treat hypertensive emergencies, can lead to an increased in cidence of adverse cardiac events. The results of large recently completed trials of long-acting CCBs in elderly hypertensive patients, however, attes t to the efficacy and safety of these agents and have also prompted their e ndorsement in the Sixth Report of the Joint National Committee on Detection , Awareness, ana Treatment of Hypertension (JNC-VI) as first-line antihyper tensive agents in the elderly. beta-blockers are ineffective as first-line therapy fur elderly hypertensiv e patients, concludes a recently published review that analyzed 10 trials i n which diuretics or beta-blockers were used as first-line drugs. beta-bloc kers were 50% less effective in lowering blood pressure and conferred no pr imary cardioprotection in elderly patients compared with diuretics. A patho physiologic mismatch may explain the poor performance of beta-blockers in o lder patients. The JNC no longer considers a-blockers appropriate for first -line monotherapy in elderly patients with hypertension.