Antihypertensive treatment according to age, plasma renin and race

Abstract

Recent large scale antihypertensive treatment trials emphasise the importance of blood pressure control in reducing both cerebrovascular accidents and myocardial infarction. Obviously therefore, the drug that best normalises blood pressure while producing the fewest adverse effects should be sought. On the basis of studies demonstrating cellular membrane and calcium homeostatic derangements and an age-dependent transition of overall cardiovascular regulation and peripheral vasoconstrictor forces during the course of essential hypertension, this review proposes an alternative treatment. Under this treatment scheme angiotensin converting enzyme inhibitors or beta-blockers should be used in younger patients and in those with high plasma renin activity, while calcium antagonists are used in place of diuretics in older low-renin or Black patients. Age-oriented 2-way drug selection enables a normalisation of blood pressure without untoward effects in about 80% of patients with essential hypertension and helps to optimise drug combinations in those patients who are difficult to treat.