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Diuretic responsiveness of blood pressure in the elderly.

The problem of elevated blood pressure in the elderly is a common and potentially devastating one. Reduction of elevated blood pressure, whether systolic, diastolic, or both, is particularly beneficial in older hypertensive subjects in reducing morbidity and mortality. The older individual presents a unique pathophysiologic situation, one in which a variety of considerations must be given to the safest choice of antihypertensive agents. A consistent response of blood pressure in the elderly is not observed with different antihypertensive agents, and the problems of side effects and as well as life-threatening effects of antihypertensive drugs are of particular concern among older hypertensive subjects. While diuretics, on balance, appear to be more effective in lowering blood pressure in older hypertensive patients than in young individuals, the disadvantages and risks of diuretic therapy make them less than ideal agents. Calcium channel blockers and serotonin antagonists have proven, in preliminary studies, to be useful, effective, and safe alternatives to diuretic therapy in older hypertensive patients.