Controversies in the use of combination therapy in the older patient.

Monotherapy of hypertension should be the goal of treatment. Even in the elderly hypertensive patient there is a good response to monotherapy with angiotensin-converting enzyme inhibitors as well as to diuretics and calcium channel blockers, despite the low plasma renin activity seen in the elderly. Adverse effects on metabolism and quality of life should be avoided in elderly patients as well as in younger hypertensive patients. Combinations of 2 drugs will not necessarily eliminate these undesirable effects, but drug combinations will be required in half of the hypertensive population. It is reasonable, when a second drug is added, to use one with a different mode of action. The role of diuretics, which have been the mainstay of antihypertensive therapy for a long time, may ultimately become that of a second drug in combination treatment.