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Calcium channel blockers in the management of hypertension in the elderly

  • Drori Ben-Ishay
    Correspondence
    Requests for reprints should be addressed to Dr. Drori Ben-Ishay, Hypertension Unit, Hadassah University Hospital, Mount Scopus, P.O. Box 24035, il-91240 Jerusalem, Israel.
    Affiliations
    Hypertension Unit, Hadassah University Hospital, Mount Scopus, and the Department of Geriatric Medicine, Ezrath-Nashim Hospital, Jerusalem, Israel
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  • Bonnie Leibel
    Affiliations
    Hypertension Unit, Hadassah University Hospital, Mount Scopus, and the Department of Geriatric Medicine, Ezrath-Nashim Hospital, Jerusalem, Israel
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  • Jochanan Stessman
    Affiliations
    Hypertension Unit, Hadassah University Hospital, Mount Scopus, and the Department of Geriatric Medicine, Ezrath-Nashim Hospital, Jerusalem, Israel
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      Abstract

      Calcium channel blockers seem to be particularly suitable for elderly hypertensive patients since these agents do not cause salt and fluid retention, postural hypotension, sedation, depression, or biochemical abnormalities. Moreover, their use is compatible with several common diseases of old age, such as diabetes, obstructive lung disease, and peripheral vascular disease. We recently conducted a study in 21 patients (average age, 79 ± 2 years) who completed an eight-week trial with 20-mg nifedipine tablets taken twice daily. Mean blood pressure decreased from 191 ± 2/96 ± 2 mm Hg to 151 ± 4/80 ± 3 mm Hg. In 15 patients (71 percent), blood pressure decreased to less than or equal to 160/90 mm Hg; in four additional patients (19 percent), diastolic blood pressure decreased by 15 to 25 percent. Thus, there was a sustained lowering of blood pressure in 90 percent of the participants receiving nifedipine monotherapy. A review of recent studies in elderly hypertensive patients revealed similarly favorable results with calcium channel blockers given alone or in combination with other agents. The accumulating data suggest that these compounds may offer a useful new approach to the treatment of hypertension in old age. However, in these studies, the number of patients and the duration of follow-up need to be extended to confirm the favorable impression obtained thus far.
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