Hypertension in the elderly

Table 5 Therapeutic strategies

Non-pharmacological strategy

Weight reduction

Dietary sodium reduction

Physical activity

Moderate alcohol consumption

Dash diet

Pharmacological strategy

Main Pharmacological agents

Thiazide diuretic: inhibiting reabsorption of sodium (Na+) and chloride (Cl-) ions from the distal convoluted tubules in the kidneys →→↓ BP, ↓ stroke, ↓ CV mortality

ACEIs: block the conversion of angiotensin I to angiotensin II →→↓ SVR, ↓ BP, ↓ mortality in patients with MI and left ventricular dysfunction, ↓ progression of diabetic renal disease

ARBs: direct blockage of angiotensin II receptors →→ vasodilation (↓SVR), ↓ secretion of vasopressin, ↓ aldosterone, ↓ BP, ↓ stroke. Generally, in patients who cannot tolerate ACEs

Calcium antagonists: disrupts the movement of calcium through calcium channels in cardiac muscle and peripheral arteries →→ vasodilation (↓ SVR), ↓ BP, ↓ CV complications in elderly patients with ISH

β blockers: ↓ heart rate, ↓ cardiac contractility, ↓ cardiac output, inhibit renin release, ↑ nitric oxide, ↓ vasomotor tone →→↓ BP

Other agents: direct renin inhibitors, aldosterone receptor antagonists, centrally acting agents, direct vasodilators, α-adrenergic blocking agents

Combination therapy

ACEIs or ARBs/Diuretic

ACEIs or ARBs/Calcium antagonist (especially in patients with high CV risk)

CV: Cardiovascular; BP: Blood pressure; ACEIs: Angiotensin converting enzyme inhibitors; ARBs: Angiotensin receptor blockers; SVR: Systemic vascular resistance.