Challenges in therapy of XXXX in the elderly.

@entity1 @entity4688 @entity101 @entity918 @entity3371 @entity916 @entity1371 @entity71014
Treating older @entity101 @entity1 presents special challenges. The physiological effects of aging result in hemodynamic and pharmacokinetic changes. Geriatric @entity1 are more likely to have concomitant diseases than younger @entity1 . Treatment regimens should be individualized; monotherapy should be the goal. While most antihypertensive agents can be used, each class of drugs has advantages and disadvantages. Diuretics are both effective and inexpensive but their metabolic side effects (especially @entity1371 ) may be quite serious in the geriatric population. Sympatholytics, beta-blockers, alpha-blockers, and direct vasodilators may not be tolerated. The angiotension-converting enzyme inhibitors, @entity3371 and @entity4688 , are good choices because they have favorable hemodynamics, @entity916 and nonrenin-dependent mechanisms of action and are associated with minimal biochemical alterations. In a recent multicenter study, @entity3371 (25 mg twice daily) was given to 99 geriatric @entity1 with seated diastolic blood pressure (BP) of 92-110 mm Hg. @entity1 whose blood pressures were not controlled after two weeks of therapy were randomized to either @entity71014 ( @entity3371 , 25 mg with 15 mg @entity918 ) or @entity3371 , 50 mg twice daily. The average decrease in BP was 16.9/11.9 mm Hg; 75.8% of @entity1 responded to treatment. Black and white @entity1 had equal responses. Only five @entity1 withdrew from the study due to adverse reactions, none of which was serious. Geriatric @entity101 should be treated. Because @entity3371 and @entity71014 are well-tolerated, effective medications in elderly @entity1 with mild, moderate, or severe @entity101 , they should be considered as initial therapy for geriatric @entity101 .
