Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension

ABSTRACT

Introduction: Hypertension is an important risk factor for developing cardiovascular diseases. It is more prevalent in the elderly population. Recently updated American and European guidelines recommend treating every elderly patient with hypertension independent of age, starting with a low dose of antihypertensive drugs. However, little information is available on the optimal dosages of antihypertensive drugs to treat the elderly safely.

Areas covered: Comorbidities, co-medication and frailty status can alter the clinical outcome of drug treatment and can cause adverse events in the elderly. Also, due to pharmacokinetic and pharmacodynamic changes the interpatient variability when using antihypertensive drugs is considerable. In this review, an overview is given on the extent to which the previously mentioned parameters are changed in elderly patients and what this means for the exposure to antihypertensive medication. Also, recommendations on the starting dose of the most frequently used antihypertensive drugs are given based on literature data.

Expert opinion: We believe that recommendations on starting dosages followed by a stepwise increase of dosages will lead to improved blood pressure control and less adverse drug reactions in the elderly patient. This may improve adherence to antihypertensive therapy.

KEYWORDS:

• Aged
• antihypertensive agents
• frailty
• hypertension
• comorbidity

Article highlights

• Treatment of hypertension in the elderly should be more aggressive than previously advocated, based on recent studies and guidelines.

• Adverse events of antihypertensive drugs in the elderly are more common because they experience more comorbidities, polypharmacy, non-adherence, and frailty.

• Pharmacokinetic and pharmacodynamic changes in elderly compared to younger patients underlie the need for lower dosages of antihypertensive drugs.

• Dose-finding starting at half or quarter dosages of antihypertensive drugs will, in general, provide a safer use in the elderly patient.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.