What is the best antihypertensive medication for a 94-year-old female?

From the Guidelines

The best antihypertensive medication for a 94-year-old female would typically be a low-dose thiazide diuretic like chlorthalidone 12.5mg daily or hydrochlorothiazide 12.5-25mg daily, or a long-acting calcium channel blocker such as amlodipine 2.5-5mg daily.

Key Considerations

• Treatment should start at the lowest possible dose with gradual titration if needed.
• For this elderly patient, blood pressure goals should be less aggressive, typically aiming for <150/90 mmHg rather than the lower targets used for younger patients.
• Medication choice must consider her specific comorbidities, current medications, and previous medication experiences.
• ACE inhibitors or ARBs may be appropriate if she has diabetes, heart failure, or kidney disease.
• Beta-blockers are generally not first-line for isolated hypertension in the elderly unless there's a specific indication like coronary artery disease.
• Treatment should prioritize avoiding orthostatic hypotension, which increases fall risk in the elderly.
• Regular monitoring of electrolytes, kidney function, and orthostatic blood pressure measurements is essential, with dose adjustments made gradually over weeks rather than days to minimize adverse effects, as supported by the American College of Physicians and American Academy of Family Physicians joint guideline 1.

Additional Guidance

• The 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults also recommends careful consideration of the patient's overall health status and potential for adverse effects when selecting antihypertensive therapy 1.
• The guideline suggests that adults aged 65 years or older with hypertension have a 10-year ASCVD risk of at least 10%, placing them in a high-risk category that requires initiation of drug therapy at an SBP of 130 mm Hg or higher, but notes that clinical judgment and patient preference should guide treatment decisions in older adults with a high burden of comorbidity and limited life expectancy 1.

From the Research

Antihypertensive Medication Options for a 94-year-old Female

• The choice of antihypertensive medication for a 94-year-old female should be based on the individual's specific health needs and medical history.
• Studies have shown that lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, is effective in reducing blood pressure in elderly patients with hypertension 2, 3, 4.
• Lisinopril has been shown to be well-tolerated and effective in elderly patients, with a low risk of adverse effects 2, 4.
• Other studies have compared the efficacy of different antihypertensive medication combinations, including lisinopril, and found them to be equally effective in reducing blood pressure and improving arterial stiffness 5, 6.

Considerations for Elderly Patients

• When selecting an antihypertensive medication for an elderly patient, it is essential to consider the potential for drug interactions and the risk of adverse effects 2, 3.
• Elderly patients may require lower doses of medication due to decreased renal function or other age-related changes 2, 4.
• The choice of medication should be individualized based on the patient's specific needs and medical history.

Efficacy of Lisinopril in Elderly Patients

• Studies have consistently shown that lisinopril is effective in reducing blood pressure in elderly patients with hypertension 2, 3, 4.
• Lisinopril has been shown to be effective in patients with various comorbidities, including congestive heart failure and diabetic nephropathy 2, 3.
• The efficacy of lisinopril in elderly patients is similar to that in younger patients, with no significant age-related differences in antihypertensive efficacy 2.