Abstract:
:The incidence of both systolic and diastolic hypertension is increased in elderly patients, therefore antihypertensive drugs are commonly used in this population. In addition to changes in blood pressure, the aging process also causes numerous changes in other physiological parameters, resulting in altered pharmacokinetic and pharmacodynamic responses to the drugs. The dosage regimens for thiazide diuretics and amiloride must be individually titrated in the elderly patient, since the elimination of these agents decreases concurrently with decreased renal function, as indicated by compromised creatinine clearance. The initial doses of the calcium antagonists should be decreased in elderly patients, since representative compounds from all 3 chemically heterogeneous classes have been shown to have decreased clearance in these patients which appears to be primarily due to the status of hepatic function in the patient. However, with verapamil, the dosage should be further decreased in association with compromised renal function. The dosage of the angiotensin converting enzyme (ACE) inhibitors should be adjusted according to renal function rather than age. Lisinopril, which is primarily eliminated unchanged, is usually given in lower doses in the elderly, and doses of both captopril and enalapril may need to be reduced, depending on renal function. While there is no need to adjust the dosage regimen for the alpha-adrenoceptor blocking drugs (prazosin, terazosin), caution should be used with the beta-adrenergic blockers, particularly the hydrophilic agents, since they are renally eliminated. Labetalol may be a suitable alternative beta-blocker for the elderly patient, since its pharmacodynamic properties of decreased systemic vascular resistance without changes in heart rate or stroke volume are preferential for the elderly patient, and its pharmacokinetics are relatively unchanged in this population. Drugs that act primarily through the central nervous system, such as clonidine, methyldopa and guanfacine, require smaller doses in the presence of renal dysfunction. In contrast, guanabenz is metabolised primarily by the liver, so it would appear to be useful in elderly patients with renal dysfunction despite the lack of studies in this population. Guanadrel, an adrenergic neuron blocking drug, also requires a dosage reduction in patients with impaired renal function. In addition to the pharmacokinetic changes that occur in the elderly patient, pharmacodynamic changes may also be anticipated due to receptor modifications. Older patients have a decrease in beta-receptor sensitivity, while alpha-receptor sensitivity does not change. When designing the dosage regimen for a senior patient with hypertension, the combination of all these variables must be considered.
journal_name
Drugs Agingjournal_title
Drugs & agingauthors
Piepho RW,Fendler KJdoi
10.2165/00002512-199101030-00004subject
Has Abstractpub_date
1991-05-01 00:00:00pages
194-211issue
3eissn
1170-229Xissn
1179-1969journal_volume
1pub_type
杂志文章,评审相关文献
DRUGS & AGING文献大全abstract:BACKGROUND:Certain medications have been linked to falls. One of the most severe fall-related injuries in the elderly is a hip fracture. OBJECTIVE:The objective of this study was to examine the use of medications known to increase fall risk that were prescribed on an outpatient basis to veterans prior to hospital admi...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/00002512-200522100-00006
更新日期:2005-01-01 00:00:00
abstract::Aging per se is associated with abnormalities of the vascular wall linked to both structural and functional changes that can take place at the level of the extracellular matrix, the vascular smooth muscle and the endothelium of blood vessels. Endothelial dysfunction is generally defined as a decrease in the capacity o...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200320070-00005
更新日期:2003-01-01 00:00:00
abstract:INTRODUCTION:Previous studies of antihypertensive treatment of older patients have focused on blood pressure control, cardiovascular risk or adherence, whereas data on inappropriate antihypertensive prescriptions to older patients are scarce. OBJECTIVES:The aim of the study was to assess inappropriate antihypertensive...
journal_title:Drugs & aging
pub_type: 杂志文章,多中心研究
doi:10.1007/s40266-017-0452-z
更新日期:2017-06-01 00:00:00
abstract::Pneumococcal polysaccharide conjugate vaccine (13-valent, adsorbed) (PCV13; Prevenar 13(®); Prevnar 13(®)) is approved in adults aged ≥50 years (focus of review) and in children aged 6 weeks to 5 years for protection against pneumococcal diseases caused by Streptococcus pneumoniae in numerous countries worldwide, incl...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-012-0017-0
更新日期:2012-10-01 00:00:00
abstract::Electronic storage of and access to medical data is becoming increasingly common. Advances in computer technology and telecommunications have made it possible to store vast amounts of information in databases and transmit this information rapidly to any place on the globe. At the forefront of this technology is the In...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199710030-00001
更新日期:1997-03-01 00:00:00
abstract:INTRODUCTION:Immunosenescence makes the elderly more susceptible to influenza complications and less responsive to vaccination. An intradermal formulation (IDflu) is one of several strategies being investigated to increase the immunogenicity of influenza vaccines. OBJECTIVE:The overall goal of the study was to assess ...
journal_title:Drugs & aging
pub_type: 杂志文章,meta分析
doi:10.1007/s40266-015-0303-8
更新日期:2015-10-01 00:00:00
abstract::The consumption of medications with anticholinergic activity has been suggested to result in the adverse effects of mental confusion, visual disturbance, and muscle weakness, which may lead to falls. Existing published evidence linking anticholinergic drugs with falls, however, remains weak. This study was conducted t...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-019-00731-3
更新日期:2020-02-01 00:00:00
abstract::An increasing number of elderly patients are exposed to cardiovascular drugs for the treatment of acute and/or chronic conditions. This is a result of the progressive aging of the population, a common feature in most industrialised countries, and an improvement in primary and secondary cardiovascular prevention strate...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200522110-00003
更新日期:2005-01-01 00:00:00
abstract:BACKGROUND:Poor medication adherence is a major public health problem in older adults often resulting in negative health outcomes. OBJECTIVE:The objective of this review was to provide an updated summary of evidence from randomized controlled studies to determine whether interventions aimed at improving medication adh...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-016-0433-7
更新日期:2017-03-01 00:00:00
abstract::Lisinopril, the lysine analogue of enalaprilat, is a long-acting angiotensin converting enzyme (ACE) inhibitor which is administered once daily by mouth. The efficacy of lisinopril in reducing blood pressure is well established in younger populations, and many trials now show it to be effective in lowering blood press...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199710020-00006
更新日期:1997-02-01 00:00:00
abstract::Faecal incontinence occurs in up to 10% of community dwelling persons > or = 65 years of age and approximately 50% of nursing home residents. It is a vastly under-reported problem that has a devastating effect on those who experience it as well as their spouses and caregivers. There are three broad categories of faeca...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200522020-00004
更新日期:2005-01-01 00:00:00
abstract::Blood pressure levels are strongly predictive of the risks of first-ever and recurrent stroke. The benefits of blood pressure-lowering therapy for the prevention of fatal and non-fatal stroke in middle-aged individuals are well established. However, until recently, there has been uncertainty about the consistency of s...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200320040-00001
更新日期:2003-01-01 00:00:00
abstract:BACKGROUND:Statins have been associated with later life, long-term care admission in observational studies. However, by preventing vascular events, statins may also prevent or delay admission. We wished to determine statin and long-term care admission associations in a randomised controlled trial context, and describe ...
journal_title:Drugs & aging
pub_type: 杂志文章,随机对照试验
doi:10.1007/s40266-018-0560-4
更新日期:2018-07-01 00:00:00
abstract::Hyperuricaemia is an independent risk factor for renal function decline. Evidence is emerging that urate-lowering therapy might be beneficial in subjects with renal impairment. We review the association between renal impairment and gout, some of the related pathogenic processes and the possible impact of gout treatme...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-018-0517-7
更新日期:2018-04-01 00:00:00
abstract::The number of older patients is increasing globally. Combined with the growing number of ambulatory surgeries, many older patients will undergo ambulatory surgery in the future. The ambulatory setting offers many advantages: early mobilization, higher patient satisfaction, lower costs, and a low incidence of several c...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-020-00803-9
更新日期:2020-12-01 00:00:00
abstract::While hormonal therapy has been the usual and appropriate treatment of advanced or metastatic prostatic cancer for the past 50 years, the recent development of new therapeutic agents as medical alternatives to orchidectomy has drastically altered the options and perspectives in the treatment of this disease. Estrogens...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199101050-00003
更新日期:1991-09-01 00:00:00
abstract:OBJECTIVE:To assess, by smoothness index (SI), distribution of the antihypertensive effect of extended-release (ER) felodipine over 24 hours in elderly patients with hypertension. METHODS:After a 4-week washout phase, 35 elderly patients (mean age 69 +/- 4 years) with mild-to-moderate hypertension received 2 weeks' tr...
journal_title:Drugs & aging
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.2165/00002512-200219070-00007
更新日期:2002-01-01 00:00:00
abstract:INTRODUCTION:Congestive heart failure (CHF), which typically affects older people, is characterized by high short- and mid-term mortality rates. However, despite accumulating evidence showing that administration of β-blockers (β-adrenoceptor antagonists) can improve the clinical status of CHF patients, use of these age...
journal_title:Drugs & aging
pub_type: 杂志文章,随机对照试验
doi:10.2165/11538210-000000000-00000
更新日期:2010-10-01 00:00:00
abstract::The finding of fungal growth in the urine (funguria) of elderly patients is becoming increasingly common. It has been reported in both acute and chronic care settings. Risk factors for the development of funguria include the use of broad spectrum antibiotics, corticosteroids and indwelling bladder catheters, as well a...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199608020-00003
更新日期:1996-02-01 00:00:00
abstract:BACKGROUND/OBJECTIVES:Patients with congestive heart failure (CHF) have a high prevalence of cognitive impairment and the association is multifactorial. In general, the burden of anticholinergic drugs has consistently been shown to be a risk factor for cognitive impairment in the elderly. The aim of this study was to a...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-014-0204-2
更新日期:2014-10-01 00:00:00
abstract::Decitabine (Dacogen(®)) is a deoxynucleoside analogue of cytidine that selectively inhibits DNA methyltransferases. Decitabine administered at a dose of 20 mg/m(2) by a 1-h intravenous infusion for 5 consecutive days of a 4-week cycle has been approved by the European Medicines Agency (EMA) for use in adult patients a...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.1007/s40266-013-0084-x
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:Temporal changes in the dispensing of glucose-lowering drugs (GLD) and their associated costs among elderly populations is unclear. This information is especially relevant to countries in which medications are partly or fully government subsidized. OBJECTIVE:Our objective was to estimate the trends in preva...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-020-00759-w
更新日期:2020-05-01 00:00:00
abstract:BACKGROUND:Improvement in renal function and decreases in serum uric acid (SUA) have been reported following prolonged high-intensity statin (HMG-CoA reductase inhibitor) therapy. This post hoc analysis of the SAGE trial examined the effect of intensive versus less intensive statin therapy on renal function, safety, an...
journal_title:Drugs & aging
pub_type: 杂志文章,随机对照试验
doi:10.1007/s40266-015-0328-z
更新日期:2015-12-01 00:00:00
abstract::There is widespread concern about the level of use, particularly the inappropriate use, of drugs among elderly residents of nursing homes. Medication consumption by these individuals is among the highest of any patient population; residents of nursing homes are prescribed an average of 5 to 8 regularly scheduled medic...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199507030-00005
更新日期:1995-09-01 00:00:00
abstract::The incidence of and mortality from both chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD) increase with age. In addition, the average age of patients with COPD and CVD is also increasing as a result of improvements in both pharmacological and non-pharmacological treatments. Coronary artery...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-200825020-00005
更新日期:2008-01-01 00:00:00
abstract::Influenza is a major cause of morbidity and mortality in the elderly. Influenza vaccine is recommended for people aged 65 years and older and those in long term care. Currently only 30% of high risk persons are vaccinated. Vaccination generally stimulates an adequate immune response, is well tolerated and is to be enc...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199101060-00003
更新日期:1991-11-01 00:00:00
abstract:BACKGROUND:Medication-related problems are common in the growing population of older adults and inappropriate prescribing is a preventable risk factor. Explicit criteria such as the Beers criteria provide a valid instrument for describing the rate of inappropriate medication (IM) prescriptions among older adults. OBJE...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/11584770-000000000-00000
更新日期:2010-12-01 00:00:00
abstract::Seasonal influenza causes significant morbidity and mortality in the elderly, the very young and those with chronic illness, despite the availability of effective vaccines. The mortality and morbidity attributed annually to seasonal influenza are small in comparison to the potential mortality and morbidity of a novel ...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.2165/00002512-200825030-00001
更新日期:2008-01-01 00:00:00
abstract::Colonoscopy is an important diagnostic and screening tool for colorectal cancer detection and prevention, and adequate bowel preparation is critical for successful colonoscopy. Complications related to colonoscopy, either directly or indirectly related to the procedure, are increased in elderly patients, and the risks...
journal_title:Drugs & aging
pub_type: 杂志文章
doi:10.1007/s40266-017-0436-z
更新日期:2017-03-01 00:00:00
abstract::The incidence of prostate carcinoma in the US now appears to be declining slightly, as a consequence of removal of prevalent cases from the population by screening. Screening for serum prostate-specific antigen (PSA) levels has been improved by the use of PSA transformations including PSA density, PSA velocity and age...
journal_title:Drugs & aging
pub_type: 杂志文章,评审
doi:10.2165/00002512-199813010-00007
更新日期:1998-07-01 00:00:00