NYMC Faculty Publications

Tolerability of Antihypertensive Medications in Older Adults

Author Type(s)

Faculty

DOI

10.1007/s40266-015-0296-3

Journal Title

Drugs & Aging

First Page

773

Last Page

796

Document Type

Article

Publication Date

10-1-2015

Department

Medicine

Keywords

Adult, Aged, Aging, Antihypertensive Agents, Diuretics, Dose-Response Relationship, Drug, Drug Interactions, Drug Therapy, Combination, Drug-Related Side Effects and Adverse Reactions, Female, Humans, Hypertension, Medication Adherence, Polypharmacy, Practice Guidelines as Topic

Disciplines

Medicine and Health Sciences

Abstract

Several guidelines for hypertension have recently undergone revisions to incorporate an approach providing choices of medications based on age, race, and specific situations where hypertension may co-exist with disorders such as diabetes, coronary artery disease, heart failure and chronic kidney disease. Initial recommendations include diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers; beta blockers are favored in some guidelines and are a choice in specific settings. Within the classes of drugs, several antihypertensive agents provide options. This review discusses antihypertensive drugs by class, including adverse effects and tolerability, with preferences in older adults and specific settings. Adverse drug events from antihypertensive medications are discussed by class and where applicable for specific agents. Data from select studies pertinent to tolerability and adverse effects are presented in tables for several classes of drugs. The rationale for nonadherence to medication is reviewed, including the roles played by tolerability and adverse drug effects. Antihypertensive therapy in typical settings in older adults is discussed; they include hypertension in association with impaired cognition, depression, diabetes, sexual dysfunction, and falls. The key to successful therapy and tolerability is to promote a healthy lifestyle in conjunction with medications as the approach, thereby also lowering the adverse drug effects. The eventual choice of the specific drug(s) is based on risks, benefits, and patient preferences, and is best tailored for each older adult.

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