Side effects of the pharmacological treatment of hypertension in the elderly [EFFETTI COLLATERALI DELLA TERAPIA FARMACOLOGICA DELL’IPERTENSIONE ARTERIOSA NEL SOGGETTO ANZIANO]

In the last two decades, several randomized, controlled trials and meta-analysis have provided strong evidence of the benefits of the pharmacological therapy of hypertension in the elderly and of the mortality and disability reduction associated with an effective control of blood pressure values. However, hypertension treatment cannot be performed only on the basis of the risk factors associated with the disease, but also taking into consideration the risks of the antihypertensive therapies. Indeed, it is well known that adverse drug reactions (ADRs) related to antihypertensive medications are particularly frequent in the elderly, also in relation to the farmacokinetic modifications associated with age (hepatic metabolism, protein binding, renal excretion, etc.), to the modifications of the receptor responses and to the elevated number of drugs related to the frequent co-morbidity. Furthermore, an important aspect to be considered is the potential interaction between anti-hypertensive agents and other drugs frequently used in the elderly, that increase the risk of ADRs. The strategies to prevent ADRs include not only a careful prescription and monitoring of the anti-hypertensive therapy, but also interventions to improve the adherence of the patients to the prescribed therapy. Anti-hypertensive treatment in the elderly should be chosen based on a comprehensive evaluation of the patient considering co-morbidity, giving preference to drugs with the minor risk of secondary effects in the single patient, and carefully monitoring the patients, searching for secondary effects that may negatively influence the quality of life.