Pharmacological backgrounds of the drug treatment of hypertension in the elderly.

A survey is given of the pharmacological backgrounds that are relevant for the drug treatment of essential hypertension in the elderly. Aging is accompanied by changes in the various autonomic receptors in the cardiovascular system, as well as in the endothelium of the large arteries. Vasodilator responses to drugs appear to be blunted in the elderly, although this effect is not necessarily caused by endothelial damage of the resistance vessels. Relevant pharmacokinetic changes associated with age are predominantly based on the continuous decrease in the renal clearance of drugs. Deficient compliance in elderly patients should be considered as a potential source of error in the drug treatment of elderly hypertensive patients. Large-scale evidence for the beneficial effect of antihypertensive drugs in the elderly with respect to morbidity and mortality is limited to diuretics and beta-blockers. The potential advantages and disadvantages of newer antihypertensives, such as ACE-inhibitors, calcium antagonists, alpha 1-adrenoceptor antagonists and urapidil are discussed on the basis of their pharmacological characteristics. Appropriate trials will be required to analyse the value of these drugs in the treatment of elderly hypertensives.