Specific patient challenge: The elderly hypertensive patient

Abstract

In a multicenter study of low-dose captopril, 97 elderly hypertensive patients were treated initially with captopril monotherapy (25 mg. twice daily). Nonresponders were assigned to treatment with either a doubled dose of captopril or a twice-daily combination of 25 mg. of captopril and 15 mg. of hydrochlorothiazide. Overall, 74 (76 percent) of the patients studied demonstrated a satisfactory response to therapy. Black and white patients responded similarly. Among patients who remained uncontrolled with the initial dosage, the group receiving the combination therapy showed a greater improvement than those assigned to 50 mg. of captopril twice daily. Only 5 percent of patients were discontinued because of side effects, and no biochemical alterations, episodes of orthostatic hypotension, or deterioration of renal function occurred. Captopril appears to be a highly suitable antihypertensive drug for use in elderly patients, including those with concomitant diseases such as diabetes, heart failure, chronic pulmonary disease, and peripheral vascular disease. In addition, its relative freedom from central side effects and adverse hemodynamic changes should enhance the quality of life for geriatric patients who require antihypertensive therapy.