Abstract
Adrenergic blocking drugs have become one of the most widely prescribed groups of agents in the current armamentarium of drugs for the treatment of a variety of cardiovascular and noncardiovascular disorders. Because diseases such as hypertension, angina, myocardial infarction, and arrhythmias are so prevalent among the elderly, beta blockers are commonly used in this population. There is, however, a significant amount of controversy involving the need to treat some of these problems in the elderly and additional doubt as to whether geriatric patients are less sensitive to the therapeutic effects of these drugs or are at greater risk of toxicity from this class of agents. The purpose of this chapter is to review the evidence documenting the efficacy of β-adrenergic blocking agents in the elderly as well as the data that quantitate the altered pharmacokinetics of beta blockers in the geriatric population. In addition, we will discuss methodology that is most appropriate to study β-blocking drugs in the elderly.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Castleden CM, George CF: The effect of aging on the hepatic clearance of propranolol. BrJ Clin Pharmacol 1979; 7: 49–54.
Barber HE, Hawksworth GM, Petrie JC, Rigby JW, Robb OJ, Scott AK: Pharmacokinetics of atenolol and propranolol in young and elderly subjects. BrJ Clin Pharmacol 1981; 2: 118P–119 P.
Quarterman CP, Kendall MJ, Jack DB: The effect of age on the pharmacokinetics of metoprolol and its metabolites. BrJ Clin Pharmacol 1981; 11: 287–294.
Regardh CG, Landahl S, Larsson M, et al: Pharmacokinetics of metroprolol and its metabolite OH-metroprolol in healthy, non-smoking, elderly individuals. Eur J Clin Pharmacol 1983; 24: 221–226.
Regardh CG, Jordo L, Ervik M, Lundborg P, Olsson R, Ronn O: Pharmacokinetics of metoprolol in patients with hepatic cirrhoses. Clin Pharmacokin 1981; 6: 375–377.
Hoffmann KJ, Regardh CG, Aurell M, Ervik M, Jordo L: The effect of impaired renal function on the plasma concentration and urinary excretion of metoprolol metabolites. Clin Pharmacokin 1980; 6: 181–191.
Jordo L, Attman PO, Aurell M, Johansson G, Regardh CG: Pharmacokinetic and pharmacodynamic properties of metoprolol in patients with impaired renal function. Clin Pharmacokin 1980; 5: 169–180.
Kelly JG, McGarry K, O’Mally K, O’Brien ET: Bioavailability of labetalol increases with age. BrJ Clin Pharmacol 1982; 14: 304–305.
Rubin PC, Scott PJW, McLean K, Pearson A, Ross D, Reid JL: Atenolol disposition in young and elderly subjects. BrJ Clin Pharmacol 1982; 13: 235–236.
Roux A, Henry JF, Fovache Y, et al: A pharmacokinetic study of acebutolol in aged subjects as compared to young subjects. Gerontology 1983; 29: 202–208.
Ishizaki T, Hirayama H, Tawara K, Nakaya H, Sato M, Sato K: Pharmacokinetics and pharmacodynamics in young normal and elderly hypertensive subjects: A study using sotolol as a model drug. J Pharmacol Exp Ther 1980; 212: 173–181.
Piafsky KM: Disease-induced changes in the plasma binding of basic drugs. Clin Pharmacokin 1980; 5: 246–262.
Geokas MC, Haverback BJ: The aging gastro-intestinal tract. AmJ Surg 1969; 117: 881.
Vestal RE, Wood AJJ: Influence of age and smoking on drug kinetics in man. Clin Pharmacokin 1980; 5: 309–319.
Hitzenberger G, Fitscha P, Beveridge T, Neusch E, Pacha W: Influence of smoking and age on pharmacokinetics of beta-receptor blockers. Gerontology 1982; 28 (suppl 1): 93–100.
Castleden CM, Kaye CM, Parsons RL: The effect of age on plasma levels of propranolol and practolol in man. Br J Clin Pharmacol 1975; 2: 303–306.
Schneider RE, Bishop H, Yates RA, Quarterman CP, Kendall MJ: Effect of age on plasma propranolol levels. BrJ Clin Pharmacol 1980; 10: 169–171.
Lennard MS, Silas JH, Freestone S, Ramsey LE, Tucker GT, Woods HF: Oxidation phenotype-A major determinant of metroprolol metabolism and response. N Engl J Med 1982; 307: 1558–1560.
Briant RH, Dorrington RE, Ferry DG, Paxton JW: Bioavailability of metoprolol in young adults and the elderly with additional studies on the effects of metaclopramide and probathine. Eur J Clin Pharmacol 1983; 25: 353–356.
Kandall MJ, Quarterman CP: The effect of age on the pharmacokinetics of oxprenolol. Int J Clin Pharmaco Ther Tox 1982; 3: 101–104.
Wan SH, Koda RT, Maronde RF: Pharmacokinetics, pharmacology of atenolol and effect of renal disease. Br J Clin Pharmacol 1979; 7: 569–579.
Reeves PR, McAinsh J, McIntosh DAD, Winrow MJ: Metabolism of atenolol in man. Xenobiotica 1978; 8: 313–320.
Fitzgerald JD, Ruffin R, Smedstad KG, Roberts R, McAinsh J: Studies on the pharmacokinetics and pharmacodynamics of atenolol in man. Eur J Clin Pharmac 1978; 13: 81–89.
Lake CR, Ziegler MG, Coleman MD, Kopin JK: Age-adjusted plasma norepinephrine levels are similar in normotensive and hypertensive subjects. N Engl J Med 1977; 296: 208–211.
Abrass IB, Scarpace PJ: Human lymphocyte beta-adrenergic receptors are unaltered with age. J Gerontol 1981; 36: 298–301.
Vestal RE, Alastair JJ, Wood MC, Shand MB: Reduced beta-adrenoreceptor sensitivity in the elderly. Clin Pharmacol Ther 1979; 26: 181–186.
Buhler RF, Burkart F, Lutold B, Kung M, Marbet G, Pfisterer M: Antihypertensive beta blocking action as related to renin and age: A pharmacologic tool to identify pathogenetic mechanism in essential hypertension. Am J Cardiol 1975; 36: 653–669.
Ostfeld AM: Elderly hypertensive patient: Epidemiologic review. NY State Med 1978; 78: 1125–1129.
Kannel WB, Gordon T: Evaluation of the cardiovascular risk in the elderly: The Framingham Study. Bull NY Acad Med 1978; 54: 573–591.
Veterans Administration Cooperative Study Group in Antihypertensive Agents: Effects of treatment on morbidity in hypertension. III. Influence of age, diastolic pressure, and prior cardovascular disease; further analysis of side effects. Circulation 1972; 45: 991–1004.
The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. Arch Intern Med 1984; 144: 1045–1047.
Goldberg PB, Roberts J: Age and responsiveness to cardiovascular drugs, in Jarvik LF, Greenblatt DJ, Harmon D (eds): Clinical Pharmacology and the Aged Patient. New York, Raven Press, 1981.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1986 Plenum Publishing Corporation
About this chapter
Cite this chapter
Roffman, D.S., Forrest, A. (1986). Beta Blockers in the Elderly. In: Cutler, N.R., Narang, P.K. (eds) Drug Studies in the Elderly. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-1253-6_12
Download citation
DOI: https://doi.org/10.1007/978-1-4684-1253-6_12
Publisher Name: Springer, Boston, MA
Print ISBN: 978-1-4684-1255-0
Online ISBN: 978-1-4684-1253-6
eBook Packages: Springer Book Archive