Evidence based medicine Antihypertensive drugs in the elderly Group 1 and 6 -Heba Othman -Heba Sabry -Reem Ahmed -Dina Reda -Dalia El Magraby

The primary goal in treating HTN should be to reach a patient goal BP, but initial selection of drugs based on HTN morbidity study results and other indications should be given priority.

Recent clinical trials(JNC) suggested that diuretics should be the first step drug of choice in most patients, but other agents should be used in special dituations. Meta-analyses suggest that the use of an agent that block RAAS is more effective in diabetics and patients with nephropathy than CCBs.

A double blind randomized, placebo controlled study -Patients(65-85 years with mild to moderate essential HTN or isolated systolic HTN). -Patients used a fixed very low dose combination of perindopril 2 mg/indapamide mg results in sustained blood pressure control when used as first line treatment over one year.

The antihypertensive and lipid lowering treatment to prevent heart attack trial (ALLHAT) reported that no overall difference in coronary heart disease outcome among patients treated with a diuretic based compared to a CCB or an ACE inhibitor., however the patients in the diuretic group experienced fewer episodes of heart failure than CCB group and fewer episodes of heart failure and stroke than those in ACE inhibitor group.

The candesartan antihypertensive survival evaluation in Japan(CASE-J) demonstrated that both candesartan and amlodipine equally suppressed the incidence of CV events. The ARB may confer more beneficial effects to hypertensive pts with LVH or for those at risk of DM than CCB.