gms | German Medical Science

Antihypertensive treatment for elderly patients with concomitant diseases is still a matter of discussion. According to ALLHAT-invetigators diuretics should be considered for first-line, but metabolic side effects of diuretics are quite common.

Is there an advantage for ACE-Inhibitors/Ca-Antagonists compared to beta-blockers/diuretics when elderly hypertensive patients are treated according to guidelines of German hypertension league considering concomitant internal diseases with regard to metabolic parameters.

Open, prospective 5-years multicenter-observation. Group (grp) 1: ACE-inhibitor (Ramipril) and/or Calcium-channel-blocker (Felodipine); grp 2: Beta1-blocker and/or diuretics. Hypertensive patients (60-80 years; >140 and/or >90 mmHg, office blood pressure (bp)).

Data could be analysed for 1311 patients in 134 medical centers which participated for 5 years. The patients were treated by decision of their physician and were asigned to the groups according to initial medication: Grp1, n=655; grp 2, n=656. All patients had at least one concomitant internal disease at study-entry (diabetes mellitus, COLD, CHD, cerebrovascular events, heart failiure, hyperuricemia, renal insufficiency, hyperlipidemia). Significant more patients with diabetes and after cerebrovascular events have initally been treated with ACE-Inhibitors/Ca-antagonists. There were significant metabolic changes from baseline to end in advantage for grp1. Grp 1 vs. 2: glucose -10.5/-1.2%; cholesterol -9.5/-6.5%; triglyceride (diabetics) -11.6/+1.4%.

Bp level was comparable during follow up and at the end. Although there were more high risk patients in grp 1 cardiovascular morbidity/total mortality was lower in grp 1 (15,6 vs. 17,4%).

ACE-inhibitors/calcium-channel-blockers have metabolic advantages in elderly patients with concomitant internal diseases in long-term treatment.