The treatment of hypertension in the elderly can be safely achieved with low-dose diuretic therapy. Men with prostatism may benefit from peripheral alpha-blocking drugs. However, drugs such as doxazosin or terazosin may further lower blood pressure and at times may be associated with orthostatic hypotension, especially if diuretics are given concomitantly. Tamsulosin achieves relaxation of the smooth muscle of the prostate, as do terazosin and doxazosin, but without provoking changes in blood pressure, especially orthostatic hypotension. There appears to be no adverse interaction with any other antihypertensive medication or with low-dose diuretics. To manage such patients with hypertension and prostatism, hydrochlorothiazide 6.25 to 12.5 mg/day and tamsulosin 0.4 mg/day would be an adequate combination. Low-dose diuretics have been shown to be effective in both isolated systolic hypertension as well as fixed diastolic hypertension in the elderly. If other antihypertensives need to be added, then a low dose of a long-acting calcium-entry blocker, a central alpha-agonist (a transdermal clonidine for better compliance), an angiotensin-converting enzyme inhibitor (if renal vascular disease has been ruled out), or an angiotensin II receptor blocker, e.g., losartan or valsartan, should be considered. (C) 1999, Elsevier Science Inc. All rights reserved.
