β-blockers as first-line therapy for hypertension in the elderly

The efficacy and safety of the calcium channel blockers (CCBs) and beta-blockers were the focus of this presentation. The CCB class of antihypertensives comprises a heterogeneous group of agents. Safety concerns over their use in patients with hypertension arose because of inappropriate and unapproved use of short-acting CCBs. It has been known for some time that nifedipine, when used to treat hypertensive emergencies, can lead to an increased incidence of adverse cardiac events. The results of large recently completed trials of long-acting CCBs in elderly hypertensive patients, however, attest to the efficacy and safety of these agents and have also prompted their endorsement in the Sixth Report of the Joint National Committee on Detection, Awareness, ana Treatment of Hypertension (JNC-VI) as first-line antihypertensive agents in the elderly. beta-blockers are ineffective as first-line therapy fur elderly hypertensive patients, concludes a recently published review that analyzed 10 trials in which diuretics or beta-blockers were used as first-line drugs. beta-blockers were 50% less effective in lowering blood pressure and conferred no primary cardioprotection in elderly patients compared with diuretics. A pathophysiologic mismatch may explain the poor performance of beta-blockers in older patients. The JNC no longer considers a-blockers appropriate for first-line monotherapy in elderly patients with hypertension.