Age and cardiovascular response adaptation. Determinants of an antihypertensive treatment concept primarily based on beta-blockers and calcium entry blockers.

Abstract

The patient's age has great impact on the development of hypertension, its duration, and severity. In patients with essential hypertension, sympathetic cardiovascular control changes from an early phase with increased beta-adrenoceptor-mediated responses, e.g., cardiac output and renin, into a later phase where these responses are blunted and alpha-adrenoceptor-mediated vasoconstriction prevails, associated with higher intracellular free sodium and calcium concentration. This pathophysiological view of essential hypertension has its corollary in the pharmacotherapeutic approach. Younger patients, who often have high renin levels, respond better to monotherapy with a beta-blocker or with a converting-enzyme inhibitor. Older patients, who often have low renin levels, respond less well to beta-blockers but particularly well to calcium entry blockers as an alternative to diuretics. Therefore, beta-blockers and calcium entry blockers form new cornerstones for antihypertensive treatment and strategy, with the potential of cardioprotection.