Skip to main content
SpringerLink
Log in

Treatment of hypertension in the elderly

  • Chapter
Drugs and the Elderly

Abstract

Many articles during recent years have discussed the pharmacotherapy of hypertension in old age. Their counsels for elderly hypertensives run the gamut from ‘… hypotensive drugs… should hardly ever be used’ (Wedgwood, 1973) and ‘… diastolic pressures up to 120 mmHg… are not an indication for therapy’ (Jackson et al 1976) to ‘…management of hypertension above 150/90 should vary with the individual’ (Burch, 1975) and ‘… regardless of the patient’s age, systolic pressure above 160 mmHg and diastolic pressure above 95 mmHg should be treated’ (Chrysant, Frohlich and Papper, 1976). The one common feature of all these recommendations is their impressionistic nature. Although they tend to sound authoritative, such articles merely express the authors’opinions and are not based on any positive knowledge. They cannot possibly be, because the benefits and risks of pharmacological reduction of blood pressure in elderly hypertensives have not been established through controlled studies.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Alderman, M. H. (1977). High blood pressure: do we really know whom to treat and how? New Engl. J. Med, 296, 753–55

    Article  Google Scholar 

  • Alderman, M. H. and Yano, K. (1976). How prevalence of hypertension varies as diagnostic criteria change. Am. J. med. Sci, 271, 343–49

    Article  Google Scholar 

  • Amery, A. and De Schaepdrijver, A. (1975). Should elderly hypertensives be treated? Lancet, i, 272–73

    Google Scholar 

  • Bender, A. D. (1965). The effect of increasing age on the distribution of peripheral blood flow in man. J. Am. Geriat. Soc, 13, 192–98

    Article  Google Scholar 

  • Brandfonbreuer, M., Landowne, M. and Shock, N. W. (1955). Changes in cardiac output with age. Circulation, 12, 557–66

    Article  Google Scholar 

  • Burch, G. E. (1975). Interesting aspects of geriatric cardiology. Am. Heart J, 89, 99–114

    Article  Google Scholar 

  • Carey, R. M., Reid, R. A., Ayers, C. R., Lynch, S. S., McLain, W. L. III and Vaughan, E. D.,Jr. (1976). The Charlottesville blood pressure study: value of repeated blood pressure measurements. J. Am. med. Ass, 236, 847–51

    Article  Google Scholar 

  • Castleden, C. M., Kaye, C. M. and Parsons, R. L. (1975). The effect of age on plasma levels of propranolol and practolol in man. Br. J. clin. Pharmac, 2, 303–6

    Article  Google Scholar 

  • Chrysant, S. G., Frohlich, E. D. and Papper, S. C. (1976). Why hypertension is so prevalent in the elderly-and how to treat it. Geriatrics, 31, 101–8

    Google Scholar 

  • Colandrea, M. A., Friedman, G. D., Nichaman, M. Z. and Lynd, C. S. (1970). Systolic hyper- tension in the elderly: an epidemiologic assessment. Circulation, 41, 239–45

    Article  Google Scholar 

  • Cooper, E. S. and West, J. W. (1977). Hypertension and stroke. Cardiovasc. Med, 2, 429–44 Crooks, J., O’Malley, K. and Stevenson, I. H. (1976). Pharmacokinetics in the elderly. Clin.Pharmacokin, 1, 280–96

    Google Scholar 

  • Davison, W. (1972). Unwanted drug effects in the elderly. In Drug-Induced Diseases, Vol. 4 (ed. L. Meyler and H. M. Peck ), Excerpta Medica, Amsterdam, pp. 617–36

    Google Scholar 

  • Dustan, H. P. (1974). Atherosclerosis complicating chronic hypertension. Circulation, 50, 871–79

    Article  Google Scholar 

  • Editorial (1977). Hypertension in the elderly. Lancet, i, 684–85

    Google Scholar 

  • Eisalo, A., Heino, A. and Munter, J. (1974). The effect of alprenolol in elderly patients with raised blood pressure. Acta med. stand, Suppl. 554, 23–31

    Google Scholar 

  • Farah, F., Taylor, W., Rawlins, M. D. and James, O. (1977). Hepatic drug acetylation and oxidation: effects of aging in man. Br. med. J, 2, 155–56

    Article  Google Scholar 

  • Feinstein, A. R. (1974). The derangements of the `range of normal’. Clin. Pharmac. Ther, 15, 528–40

    Google Scholar 

  • Fishback, D. B. (1976). An approach to the treatment of hypertension in the aged. Angiology, 27, 212–18

    Article  Google Scholar 

  • Freis, E. D. (1972). Hypertension: a controllable disease. Clin. Pharmac. Ther, 13, 627–32

    Google Scholar 

  • Friedman, S. A., Raizner, A. E., Rosen, H., Solomon, N. A. and Sy, W. (1972). Functional defects in the aging kidney. Ann. int. Med, 76, 41–45

    Article  Google Scholar 

  • Gorrod, J. W. (1974). Absorption, metabolism and excretion of drugs in geriatric subjects. Gerontol. Clin, 16, 30–42

    Article  Google Scholar 

  • Goss, L. Z., Rosa, R. M. F. and O’Brien, W. M. (1969). Predicting death from renal failure in primary hypertension. Archs intern. Med, 124, 160–64

    Article  Google Scholar 

  • Greenblatt, D. J., Duhme, D. W., Allen, M. D. and Koch-Weser, J. (1977). Clinical toxicity of furosemide in hospitalized patients. A report from the Boston Collaborative Drug Surveillance Program. Am. Heart J, 94, 6–13

    Article  Google Scholar 

  • Greenblatt, D. J. and Koch-Weser, J. (1973a). Adverse reactions to spironolactone. A report from the Boston Collaborative Drug Surveillance Program. J. Am. med. Ass, 225, 40–43

    Article  Google Scholar 

  • Greenblatt, D. J. and Koch-Weser, J. (1973b). Adverse reactions to propranolol in hospitalized medical patients. A report from the Boston Collaborative Drug Surveillance Program. Am. Heart J, 86, 478–84

    Article  Google Scholar 

  • Gubner, R. S. (1962). Systolic hypertension: a pathogenic entity. Significance and therapeutic considerations. Am. J. Cardiol, 9, 773–76

    Article  Google Scholar 

  • Hall, M. R. P. (1973). Drug therapy in the elderly. Br. med. J, 3, 582–84

    Article  Google Scholar 

  • Hallock, P. and Benson, I. C. (1937). Studies on the elastic properties of human isolated aorta. J. clin. Invest, 16, 595–602

    Article  Google Scholar 

  • Hamilton, M., Thompson, E. N. and Wisniewski, T. K. M. (1964). The role of blood pressure control in preventing complications of hypertension. Lancet, i, 235–38

    Google Scholar 

  • Hansen, J. M., Kampmann, J. and Laursen, M. (1970). Renal excretion of drugs in the elderly. Lancet, i, 1170

    Google Scholar 

  • Harris, R. (1970). The Management of Geriatric Cardiovascular Disease, Lippincott, Philadelphia

    Google Scholar 

  • Ho, J. K„ Lin, L. Y. and Galysh, F. T. (1972). Aortic compliance: studies on its relationship to aortic constituents in man. Archs Path, 94, 537–46

    Google Scholar 

  • Hypertension Detection and Follow-Up Program Cooperative Group (1977). The hypertension detection and follow-up program. A progress report. Circ. Res, 40, Suppl. 1, 106–9

    Google Scholar 

  • Hypertension-Stroke Cooperative Study Group (1974). Effect of antihypertensive treatment on stroke recurrence. J. Am. med. Ass, 229, 409–18

    Article  Google Scholar 

  • Jackson, G., Pierscianowski, T. A., Mahon, W. and Condon, J. (1976). Inappropriate antihypertensive therapy in the elderly. Lancet, ii, 1317–18

    Google Scholar 

  • Johnsson, G. and Regardh, C.-G. (1976). Clinical pharmacokinetics of 3-adrenoreceptor blocking drugs. Clin. Pharmacokin, 1, 233–63

    Article  Google Scholar 

  • Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (1977). Report of the committee. J. Am. med. Ass, 237, 255–61

    Article  Google Scholar 

  • Kannel, W. B. (1974). Role of blood pressure in cardiovascular morbidity and mortality. Prog. Cardiovasc. Dis, 17, 5–24

    Article  Google Scholar 

  • Kannel, W. B., Castelli, W. P., McNamara, P. M., McKee, P. A. and Feinleib, M. (1972). Role of blood pressure in the development of congestive heart failure. The Framingham study. New Engl. J. Med, 287, 781–87

    Article  Google Scholar 

  • Kannel, W. B., Dawber, T. R., Sorlie, P. and Wolf, P. A. (1976). Components of blood pressure and risk of atherothrombotic brain infarction: the Framingham study. Stroke, 7, 327–31

    Article  Google Scholar 

  • Kannel, W. B. and Gordon, T. (eds.) (1974). The Framingham Study. An Epidemiologic Investi-gation of Cardiovascular Disease. U. S. Government Printing Office, Washington, D. C.

    Google Scholar 

  • Kannel, W. B., Gordon, T. and Offutt, D. (1969). Left ventricular hypertrophy by electro-cardiogram: prevalence, incidence and mortality in the Framingham study. Ann. intern.Med, 71, 89–105

    Article  Google Scholar 

  • Kannel, W. B., Gordon, T. and Schwartz, M. J. (1971). Systolic versus diastolic blood pressure and risk of coronary heart disease: the Framingham study. Am. J. Cardiol, 27, 335–46

    Article  Google Scholar 

  • Kannel, W. B., Wolf, P. A., Verter, J. and McNamara, P. M. (1970). Epidemiologic assessment of the role of blood pressure in stroke: the Framingham study. J. Am. med. Ass, 214, 301–10

    Article  Google Scholar 

  • Koch-Weser, J. (1973a); Correlation of pathophysiology and pharmacotherapy in primary hypertension. Am. J. Cardiol, 32, 499–510

    Article  Google Scholar 

  • Koch-Weser, J. (1973b). The therapeutic challenge of systolic hypertension. New Engl. J. Med, 289, 481–83

    Article  Google Scholar 

  • Koch-Weser, J. (1974a). Vasodilator drugs in the treatment of hypertension. Arch. intern. Med, 133, 1017–27

    Article  Google Scholar 

  • Koch-Weser, J. (1974b). Individualization of antihypertensive drug therapy. Med. Clin. North Am, 58, 1027–36

    Google Scholar 

  • Koch-Weser, J. (1975). Drug interactions in cardiovascular therapy. Am. Heart J, 90, 93–116 Koch-Weser, J. (1976a). Hydralazine. New Engl. J. Med, 295, 320–23

    Article  Google Scholar 

  • Koch-Weser, J. (1976b). Modern approaches to the treatment of hypertension. In Clinical Pharmacy and Pharmacology (ed. W. A. Gouveia, G. Tognoni and E. v. d. Kleijn ), Elsevier/North Holland Biomedical Press, Amsterdam, pp. 93–104

    Google Scholar 

  • Koch-Weser, J. and Sellers, E. M. (1976). Binding of drugs to serum albumin. New Engl. J. Med, 294, 311–16, 526–31

    Article  Google Scholar 

  • Lindeman, R. D., Bouthilet, G. N., Ashley, W. R. and Morris, J. R. (1963). Effect of hydro-chlorothiazide-reserpine therapy on cerebral function in elderly hypertensives. J. Am. Geriat. Soc, 2, 597–606

    Article  Google Scholar 

  • Lundborg, P. and Steen, B. (1976). Plasma levels and effect on heart rate and blood pressure of metoprolol after acute oral administration in 12 geriatric patients. Acta med. stand.., 200, 397–402

    Google Scholar 

  • MacFarlane, I. F. R. and Kennedy, R. D. (1973). Clinical experience with amiloride in the elderly. Acta Cardiol, 28, 365–74

    Google Scholar 

  • Master, A. M. (1952). Normal Blood Pressure and Hypertension, Lea and Febiger, Philadelphia

    Google Scholar 

  • Master, A. M. and Lasser, R. P. (1961). Blood pressure elevation in the elderly. In Hypertension:Recent Advances (ed. A. N. Brest and J. H. Moyer ), Lea and Febiger, Philadelphia, pp. 24–34

    Google Scholar 

  • Meyer, J. S., Sawada, R., Kitamura, A. and Toyoda, M. (1968). Cerebral blood flow after con-trol of hypertension in stroke. Neurology, 18, 772–81

    Article  Google Scholar 

  • Miall, W. E. and Chinn, S. (1974). Screening for hypertension: some epidemiologic observations. Br. med. J, 3, 595–600

    Article  Google Scholar 

  • O’Malley, K., Crooks, J., Duke, E. and Stevenson, I. H. (1971). Effect of age and sex on human drug metabolism. Br. med. J, 3, 607–9

    Article  Google Scholar 

  • O’Malley, K., Judge, T. G. and Crooks, J. (1976). Geriatric clinical pharmacology and thera-peutics. In Drug Treatment (ed. G. S. Avery ), Adis Press, Sidney, pp. 123–42

    Google Scholar 

  • Page, L. P. and Sidd, J. J. (1972). Medical management of arterial hypertension. New Engl. J.Med, 287, 960–67

    Article  Google Scholar 

  • Papper, S. (1973). The effects of age in reducing renal function. Geriatrics, 28, 83–87

    Google Scholar 

  • Paul, O. (1971). Risks of mild hypertension: a ten-year report. Br. Heart J, 33 (suppl.), 116–21

    Article  Google Scholar 

  • Perry, H. M. (1977). Treatment of mild hypertension. Preliminary results of a two-year feasi-bility trial. Circ. Res, 40, suppl. 1, 180–87

    Google Scholar 

  • Pfeifer, H. J., Greenblatt, D. J. and Koch-Weser, J. (1976). Clinical toxicity of reserpine in hospitalized patients. A report from the Boston Collaborative Drug Surveillance Program. Am. J. med. Sei, 271, 269–76

    Article  Google Scholar 

  • Pfeifer, H. J., Greenblatt, D. J. and Koch-Weser, J. (1977). Adverse reactions to practolol in hospitalized patients. A report from the Boston Collaborative Drug Surveillance Program. Eur. J. clin. Pharmac, 12, 167–70

    Article  Google Scholar 

  • Proger, S. (1972). Antihypertensive drugs: praise and restraint. New Engl. J. Med, 286, 155–56

    Article  Google Scholar 

  • Ramirez, E. A. and Pont, P. H. G. (1965). Relation of arterial blood pressure to the transverse diameter of the heart in compensated hypertensive heart disease. Circulation, 31, 542–50

    Article  Google Scholar 

  • Richey, D. P. and Bender, A. D. (1977). Pharmacokinetic consequences of aging. A. Rev.Pharmac. Tox, 17, 49–65

    Article  Google Scholar 

  • Seligman, A. W., Alderman, M. H., Engelland, A. L. and Davis, T. K. (1977). Treatment of systolic hypertension. Clin. Res, 25, 254A

    Google Scholar 

  • Smith, W. M. (1977). Treatment of mild hypertension. Results of a ten-year intervention trial. Circulation Res, 40, suppl. 1, 98–105

    Google Scholar 

  • Society of Actuaries (1959). Build and Blood Pressure Study. Chicago

    Google Scholar 

  • Strandgaard, S. (1976). Autoregulation of cerebral blood flow in hypertensive patients. Circulation, 53, 720–27

    Article  Google Scholar 

  • Tarazi, R. C., Magrini, F. and Dustan, H. P. (1975). The role of aortic distensibility in hypertension. In Advances in Hypertension, Vol. II (ed. P. Milliez and M. Safar ), Boehringer, Ingelheim, pp. 133–42

    Google Scholar 

  • Triggs, E. J. and Nation, R. L. (1975). Pharmacokinetics in the aged: a review. J. Pharmacokin. Biopharm, 3, 387–418

    Article  Google Scholar 

  • Triggs, E. J., Nation, R. L., Long, A. and Ashley, J. J. (1975). Pharmacokinetics in the elderly. Eur. J. clin. Pharmac, 8, 55–62

    Article  Google Scholar 

  • United States National Center for Health Statistics (1977). Blood pressure levels of persons 6–74 years of age in the United States. Government Printing Office, Series II, No. 203, Rockville, Maryland

    Google Scholar 

  • Veterans Administration Cooperative Study Group on Antihypertensive Agents (1967). Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 to 129 mmHg. J. Am. med. Ass, 202, 1028–34

    Article  Google Scholar 

  • Veterans Administration Cooperative Study Group on Antihypertensive Agents (1970): Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure averaging 90 through 114 mmHg. J. Am. med. Ass, 213, 1143–52

    Article  Google Scholar 

  • Veterans Administration Cooperative Study Group on Antihypertensive Agents (1972). Effects of treatment on morbidity in hypertension. III. Influence of age, diastolic pressure and prior cardiovascular disease; further analysis of side effects. Circulation, 45, 991–1004

    Article  Google Scholar 

  • Wedgwood, J. (1973). Cardiovascular disease in the old. Br. med. J., 3, 622–26

    Google Scholar 

  • Zacest, R., Gilmore, E. and Koch-Weser, J. (1972). Treatment of essential hypertension with combined vasodilation and beta-adrenergic blockade. New Engl. J. Med, 286, 617–22

    Article  Google Scholar 

  • Zacest, R. and Koch-Weser, J. (1972). Relation of propranolol plasma level to beta-blockade during oral therapy. Pharmacology, 7, 178–84

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre de Recherche Merrell International, Strasbourg, France

    Jan Koch-Weser

Authors
  1. Jan Koch-Weser
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Pharmacology and Therapeutics, Ninewells Hospital, Dundee, UK

    J. Crooks  & I. H. Stevenson  & 

Copyright information

© 1979 J. Crooks and I. H. Stevenson

About this chapter

Cite this chapter

Koch-Weser, J. (1979). Treatment of hypertension in the elderly. In: Crooks, J., Stevenson, I.H. (eds) Drugs and the Elderly. Palgrave Macmillan, London. https://doi.org/10.1007/978-1-349-03813-8_23

Download citation

Publish with us

Policies and ethics

Search

Navigation