Hypertension in the elderly: the role of calcium antagonists.

Calcium antagonists have a spectrum of actions that opposes many of the pathophysiological abnormalities found in hypertension in old age. There is good evidence that these drugs reduce blood pressure effectively in the elderly. There is no evidence from controlled studies to indicate that they are more effective in elderly than in young subjects. There is equally no convincing evidence that age is an independent predictor of hypotensive efficacy of calcium channel antagonists, after the effect of pretreatment blood pressure and random variation have been taken into account. There have been no studies comparing the efficacy of calcium antagonists with other classes of antihypertensive drugs in old age, and there is no evidence that any one group of calcium antagonists is superior in this age group. There have been no studies demonstrating that calcium antagonists have a beneficial effect on the morbidity and mortality associated with hypertension in the elderly, or indeed in any age group. Side effects are equally common in old and young subjects and are usually mild. Overall, calcium antagonists are valuable and appropriate drugs for the treatment of hypertension in the elderly. They may be particularly useful for treating hypertension associated with conditions that occur with increased frequency in the elderly such as peripheral vascular disease, ischemic heart disease, cardiac arrhythmias, and obstructive airways disease. Since plasma concentrations of these drugs may be elevated in elderly patients due to altered pharmacokinetics, therapy should be started with low doses and increased gradually.