Hypertension: Drug therapy options for older patients

For the older patient with uncomplicated hypertension, JNC-VI recommends a low-dose thiazide diuretic as first-line drug therapy. If control is not achieved, it is often necessary to add a second or third agent. Cardioselective beta blockers are useful with concomitant coronary artery disease and are compelling post-MI. ACE inhibitors are useful in combination with a diuretic and for patients with congestive heart failure. Angiotensin II receptor blockers have some of the benefits of ACE inhibitors and a side effect profile similar to placebo. Alpha blockers can be very effective, especially when combined with calcium channel blockers or beta blockers. The dihydropyridine calcium antagonists have been shown to reduce morbidity and the incidence of stroke. Whatever the drug therapy, blood pressure control in older patients reduces the risk of stroke, coronary artery disease, and congestive heart failure.