Hypertension: Drug therapy options for older patients - Part 3

For the older patient with uncomplicated hypertension, JNC-VI recommends a low-dose thiazide diuretic as first-line drug therapy. If control is not ac hieved,it is often necessary to add a second or third agent. Cardioselectiv e beta blockers are useful with concomitant coronary artery disease and are compelling post-MI. ACE inhibitors are useful in combination with a diuret ic and for patients with congestive heart failure. Angiotensin II receptor blockers have some of the benefits of ACE inhibitors and a side effect prof ile similar to placebo. Alpha blockers can be very effective, especially wh en combined with calcium channel blockers or beta blockers. The dihydropyri dine calcium antagonists have been shown to reduce morbidity and the incide nce of stroke. Whatever the drug therapy, blood pressure controling older p atients reduces the risk of stroke, coronary artery disease, and congestive heart failure.