Antihypertensive therapy. Is it different in the elderly?

Pathophysiological mechanisms of pressure elevation are different in the elderly hypertensive patient than in middle-aged or young patients. The elderly patient is characterised by a decrease in cardiac output, renal blood flow, and intravascular volume and an increase in total peripheral resistance and vascular resistance. Elderly patients also, quite often, have target organ disease such as left ventricular hypertrophy and nephrosclerosis. Because of impaired baroreflexes and latent or overt cerebrovascular disease, the elderly patient is particularly susceptible to abrupt falls in arterial pressure. Clearly, these physiological findings have to be taken into account when prescribing antihypertensive therapy. Calcium channel blockers and converting enzyme inhibitors seem to be particularly useful in the geriatric population. A close match between the underlying pathophysiology of pressure elevation in a given patient and the pharmacological effects of a selected antihypertensive drug will provide more rational and convenient control of arterial pressure in our senior citizens.