Demographic considerations in the selection of antihypertensive therapy

Abstract

Because of the growing number of antihypertensive agents that are suitable for initial therapy in mild and moderate hypertension, it is important to identify factors that influence the response to various medications. Although individual patient considerations, such as associated illnesses and potential side effects, are of primary importance in choosing therapy, the influence of demographic factors has received increasing attention. The effect of age, race and gender on the response to antihypertensive therapy will be examined. Several studies have indicated that the β blockers and angiotensin converting enzyme (ACE) inhibitors are more effective in younger than in older patients. Conversely, there is a trend toward greater responses in older subjects to the diuretics and calcium antagonists. In the few studies available that have compared agents in various classes, it appears that diuretics, and probably calcium antagonists, are significantly more effective than β blockers or ACE inhibitors in patients over 60 years of age. However, the interdrug differences in young patients are probably less important. With regard to race, the relative lack of effect of β blockers and ACE inhibitors in blacks is well accepted; in comparative studies, diuretics proved significantly better. From the few available studies, it does not appear that the calcium antagonists are more potent in either racial group, but they may be superior to the β blockers and ACE inhibitors in blacks. Far less information is available concerning differences in anti-hypertensive responses between men and women. There is some suggestion that women may be less responsive to β blockers than men. Although these demographic differences are not of great magnitude, they should be considered in selecting an initial medication when other factors are equal.