What is the Safest Medication for Hypertension After 60?

Hypertension, or high blood pressure, is common in middle-aged and elderly people and can lead to cardiovascular disease and death from stroke, heart attack or heart failure. Older people are at an increased risk for drug interactions and adverse drug effects, but several safe and effective options exist for the treatment of hypertension.

Goals of Hypertension Treatment

• Most people have a blood pressure goal of less than 140/90 mmHg. In patients with diabetes or other chronic diseases, a lower goal of 130/80 mmHg may be appropriate.

First-line Treatment of Hypertension

• Thiazide diuretics are considered first-line therapy for treatment of high blood pressure in the elderly due to their safety and effectiveness. Examples of thiazide diuretics include indapamide, chlorthalidone, and hydrochlorothiazide.

Alternative Treatment Options

• Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers and calcium channel blockers may be used to lower blood pressure in the elderly. Lower-than-usual starting doses should be used and the dose should be increased slowly to achieve the appropriate blood pressure goal.

Drugs to Avoid

• Alpha-blockers should generally not be used in the elderly due to the significant risk of extremely low blood pressure.

Safety Concerns

• All blood pressure drugs can be problematic in elderly patients since the elderly are more likely to experience low blood pressure as a side effect, leading to dizziness and falls. Also, elderly people often have multiple chronic conditions and medications, resulting in an increased risk of drug-drug and drug-food interactions.

Warning

• All patients should discuss the risks and benefits of all available treatment options with their health care provider to decide which drug is right for them.