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Age-Dependent Differences in the Efficacy and Tolerability of Different Classes of Antihypertensive Drugs

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Summary

The present study evaluated the age-related differences in antihypertensive response and drug-related adverse effects of 3 antihypertensive drugs from different classes in a younger and an older population of patients with mild to moderate essential hypertension. The β-blocker bisoprolol 5mg once daily, the diuretic bendrofluazide 2.5mg once daily or the calcium antagonist nifedipine retard 10mg twice daily were evaluated using double-blind techniques for antihypertensive efficacy, tolerability and influence on well-being. 154 patients (70 men, 84 women) were randomised; there were equal numbers (77) of younger and elderly patients. Adequate control of blood pressure (diastolic blood pressure < 95mm Hg) was achieved in a total of 96 (71.6%, CI: 63.8 to 79.4%) of the young and 114 (83.8%, CI: 77.6 to 90.0%) of the elderly patients when all 3 active treatment groups were included (p < 0.05). The response rate was significantly higher in the elderly. The response to low dosages was also significantly (p < 0.05) higher in the elderly (58.0%, CI 47.7 to 66.3%) than in the younger (50.0%, CI 41.6 to 58.4%) patients during active treatment. The general wellbeing was similar for all quality-of-life variables in both age groups during placebo phases and active treatment phases or between treatment groups. The control of high blood pressure can be achieved with antihypertensive drugs from different classes. Elderly people tend to respond better to antihypertensive monotherapy than younger patients. Adverse effects of the drug regimens did not influence the feeling of well-being in both age groups.

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References

  1. Kaplan NM. South-western Internal Medicine Conference: the promises and perils of treating the elderly hypertensive. Am J Med Sci 1993; 3: 305

    Google Scholar 

  2. Dahlöf B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 11: 338

    Google Scholar 

  3. Lavrijssen ATJ, de Leeuw PW. Hypertension in the elderly: a brief overview. Neth J Cardiol 1993; 1: 16–20

    Google Scholar 

  4. Cushman WC, Khatri I, Materson BJ, et al. Treatment of hypertension in the elderly. Response of isolated systolic hypertension to various doses of hydrochlorothiazide: results of a Department of Veterans Affairs Co-operative study. Arch Intern Med 1991; 151: 1954–60

    Article  PubMed  CAS  Google Scholar 

  5. Clamp M, Holmes B, Wilcox R. Comparative trial of nifedipine retard and atenolol in the treatment of elderly patients with mild to moderate hypertension. J Hum Hypertens 1990; 4: 557–63

    PubMed  CAS  Google Scholar 

  6. Shapiro DA, Liss CL, Walker JF, et al. Enalapril and hydrochlorothiazide as antihypertensive agents in the elderly. J Cardiovasc Pharmacol 1987; 10Suppl. 7: S160–62

    Article  PubMed  Google Scholar 

  7. Fletcher A, Amery A, Birkenhäger W, et al. Risks and benefits in the trial of the European Working Party on High Blood Pressure in the Elderly. J Hypertens 1991; 9: 225–30

    Article  PubMed  CAS  Google Scholar 

  8. Dahlöf B, Lindholm LH, Hansson L, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991; 338: 1281–5

    Article  PubMed  Google Scholar 

  9. Curb JD, Pressel SL, Cutler JA, et al., for the Systolic Hypertension in Elderly Co-Operative Research Group. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older persons with isolated systolic hypertension. JAMA 1996; 276: 1886–92

    Article  PubMed  CAS  Google Scholar 

  10. MRC Working Party. Medical Research Council trial of treatment of hypertension in older adults: principal results. BMJ 1991; 304: 305–12

    Google Scholar 

  11. Buhler FR, Burkart F, Lutold BE, et al. Antihypertensive β-blocking action as related to renin and age: a pharmacologic tool to identify pathogenic mechanisms in essential hypertension. Am J Cardiol 1975; 36: 653–69

    Article  PubMed  CAS  Google Scholar 

  12. Neutel JM, Smith DHG, Ram CVS, et al, for the Bisoprolol Investigators Group. Comparison of bisoprolol with atenolol for systemic hypertension in four population groups (young, old, black and nonblack) using ambulatory blood pressure monitoring. Am J Cardiol 1993; 7: 72

    Google Scholar 

  13. Bühler FR. Age and pathophysiology-oriented antihypertensive response to calcium antagonists. J Cardiovasc Pharmacol 1988; 12Suppl. 8: S156–62

    PubMed  Google Scholar 

  14. Nicholls MG. Age-related effects of diuretics in hypertensive subjects. J Cardiovasc Pharmacol 1988; 12Suppl. 8: S51–9

    PubMed  Google Scholar 

  15. Freis ED. Veterans Administration Co-Operative Study Group on hypertensive agents: effects of age on treatment results. Am J Med 1991; 90Suppl. 3A: 20S–23S

    Article  PubMed  CAS  Google Scholar 

  16. Bulpitt CJ, Fletcher AE. The measurement of quality of life in hypertensive patients — a practical approach. Br J Clin Pharmacol 1990; 30: 353–64

    Article  PubMed  CAS  Google Scholar 

  17. Koch GG. The use of non parametric methods in the statistical analysis of the two period change over design. Biometrics 1972; 28: 577–84

    Article  PubMed  CAS  Google Scholar 

  18. Gillings D, Koch GG. The applications of the principle of intention to treat to the analysis of clinical trials. Drug Info J 1991; 25: 411–24

    Article  Google Scholar 

  19. Sörensen K, Hilden T. Increased total mortality and decreased functional capacity are associated with low systolic blood pressure among elderly women. Scand J Prim Health Care 1988; 6: 105–10

    Article  PubMed  Google Scholar 

  20. Holme I, Waaler T. Five-year mortality in the city of Bergen, Norway, according to age, sex and blood pressure. Acta Med Scand 1976; 200: 229–39

    Article  PubMed  CAS  Google Scholar 

  21. Agner E. Predictive value of arterial blood pressure in old age. Acta Med Scand 1983; 214: 285–94

    Article  PubMed  CAS  Google Scholar 

  22. Landahl S, Lernfelt B, Sundh V. Blood pressure and mortality in old age: eleven years’ follow-up of a 70-year-old population. J Hypertens 1987; 5: 745–8

    Article  PubMed  CAS  Google Scholar 

  23. Kannel W, Gordon T. Evaluation of cardiovascular risk in the elderly: the Framingham study. Bull NY Acad Med 1978; 54: 573–91

    CAS  Google Scholar 

  24. Kannel WB, Cupples A, D’Agostino RB, et al. Hypertension, anti-hypertensive treatment, and sudden coronary death. The Framingham Study. Hypertension 1988; 11Suppl. II: II–45–50

    Google Scholar 

  25. Clausen J, Jensen G. Blood pressure and mortality: an epidemiological survey with 10 years follow-up. J Hum Hypertens 1992; 6: 53–9

    PubMed  CAS  Google Scholar 

  26. McAllister RG. Age-related changes in drug handling in man. Am J Cardiol 1986; 57: 39C–62C

    Google Scholar 

  27. Goldstein G. Hypertension and cognitive function in the elderly. Cardiovasc Risk Factors 1991; 2: 127–32

    Google Scholar 

  28. Goldstein G, Materson BJ, Cushman WC, et al. Treatment of hypertension in the elderly: II. Cognitive and behavioural function. Results of a Department of Veterans Affairs Co-Operative Study. Hypertension 1990; 15: 361–9

    Article  PubMed  CAS  Google Scholar 

  29. Applegate WB. Hypertension in elderly patients. Ann Intern Med 1989; 110: 901–15

    PubMed  CAS  Google Scholar 

  30. Lipsitz LA, Nyquist RP Jr, Wei JY, et al. Postprandial reduction in blood pressure in the elderly. N Engl J Med 1983; 309: 81–3

    Article  PubMed  CAS  Google Scholar 

  31. Buhler FR. Age and pathophysiology-oriented antihypertensive response to calcium antagonists. J Cardiovasc Pharmacol 1988; 12Suppl. 8: S156–S162

    PubMed  Google Scholar 

  32. Kaplan NM. Critical comments on recent literature. Age and the response to antihypertensive drug. Am J Hypertens 1989; 2: 213–5

    PubMed  CAS  Google Scholar 

  33. Zing W, Ferguson RK, Vlasses PH. Calcium antagonists in elderly and black hypertensive patients. Therapeutic controversies. Arch Intern Med 1991; 151: 2154–62

    Article  PubMed  CAS  Google Scholar 

  34. Furberg CD, Patsy BM, Meyer JV. Nifedipine, dose related increase in mortality in patients with coronary heart disease. Circulation 1995; 92: 1326–31

    Article  PubMed  CAS  Google Scholar 

  35. Patsy BM, Heckbert SR, Koepsell TD, et al. The risk of myocardial infarction associated with antihypertensive treatment. JAMA 1995; 274: 620–5

    Article  Google Scholar 

  36. Yusuf S. Calcium-antagonists in coronary artery disease and hypertension. Time for reevaluation [editorial]. Circulation 1995; 92: 1079–82

    Article  PubMed  CAS  Google Scholar 

  37. Kloner RA. Nifedipine in ischemie heart disease. Circulation 1995; 92: 1074–8

    Article  PubMed  CAS  Google Scholar 

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van de Ven, L.L.M. Age-Dependent Differences in the Efficacy and Tolerability of Different Classes of Antihypertensive Drugs. Clin. Drug Investig. 14, 16–22 (1997). https://doi.org/10.2165/00044011-199714010-00003

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