The management of hypertension in older patients.

Hypertension need not be a natural consequence of aging; nevertheless, as many as 70% of individuals aged 70 years or more have diastolic blood pressures greater than or equal to 90 mm Hg and/or systolic blood pressures greater than 160 mm Hg. Well-controlled trials have documented significant reductions in cardiovascular mortality with treatment of diastolic elevation. Double-blind, long-term, open-label studies have been conducted of quinapril, a new angiotensin-converting enzyme (ACE) inhibitor, in 451 older patients compared with 1,887 younger patients. Results of these studies showed that quinapril is equally effective in older and younger patients. The studies also demonstrated that the safety of quinapril in the treatment of older patients is comparable with that in younger patients, in terms of both the incidence of adverse events and the types of adverse events reported. However, because many older patients have impaired renal function, which can prolong the half-life of renally excreted ACE inhibitors such as quinaprilat (the active metabolite of quinapril), they should be started on lower doses of quinapril (5 mg) than are used in younger patients. The shorter half-life and duration of action of quinaprilat compared with other once-daily ACE inhibitors may make quinapril better suited than these other agents for use in older patients.