Treatment of arterial hypertension with diuretics, beta- and calcium channel blockers in old patients

Hypertension increases in prevalence with age. Population based studies sug gest that more than 50% of people over the age of 65 years may have chronic hypertension. Hypertension, especially systolic hypertension, is the single most common, powerful, however, treatable risk factor for cardiovascular morbidity and m ortality in the elderly. In order to assess the effectiveness of antihypertensive drug therapy among the elderly, with diuretics, beta-blockers and calcium channel blockers, a literature search was performed at the Cochrane Library, Medline and Excer pta medica. The Cochrane Hypertension Group identified 14 randomised controlled trials of at least one year duration with 21 785 elderly subjects where diuretics, beta-blockers or calcium channel blockers were used in the treatment group as first line drugs. In their meta-analysis (including one small trial wit h a central acting antiadrenergic drug) there was a decrease in total morta lity (111 vs 129 deaths) and cardiovascular morbidity and mortality (126 vs 177 events) within the treatment group. The three trials restricted to persons with isolated systolic hypertension indicated beneficial effects in the treatment group with regard to cardiova scular morbidity and mortality (104 vs 157 events). Trial data on adverse effects is limited. In three studies, where adverse e ffects were reported, no substantial differences between treatment and cont rol groups in measures of physical, cognitive and emotional function were f ound. Cardiovascular benefits of treatment with low dose diuretics or beta-blocke rs are cleared for elderly subjects with either diastolic or isolated systo lic hypertension. Treatment with a long-acting dihydropyridine calcium chan nel blocker shows beneficial effects in reducing cardiovascular morbidity a nd mortality for elderly people with isolated systolic hypertension. Due to inconsistent findings in a subgroup mete-analysis of antihypertensiv e drug treatment in very old people, the efficacy of antihypertensive treat ment in these subjects still remains unclear.