Converting enzyme inhibitors for the treatment of hypertension in the elderly.

Recent epidemiological studies have confirmed that high blood pressure increases the risk of cardiovascular morbidity and mortality not only in young and middle-aged subjects but also in elderly patients. For this reason there is an increasing tendency to treat hypertension also in this age group. However in doing so several problems may be encountered, if the particular physiopathological characteristics of these patients are not taken into account. Recently captopril has been proposed as a useful agent in these cases since it does not reduce coronary, cerebral and renal blood flow and does not cause orthostatic hypotension. These properties are of the utmost importance because elderly patients often present a decreased renal function, ischaemic heart disease, cerebrovascular disease and an impaired baroreflex sensitivity. Although to date no controlled studies have been published on the use of captopril in hypertensives over 60 years old, the results of a recent captopril surveillance programme indicate that this agent is efficacious and well tolerated in these patients.