Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension

L E J Peeters, M P Kester, L Feyz, P M L A Van Den Bemt, B C P Koch, T Van Gelder, J Versmissen

Research output: Contribution to journalReview articlepeer-review

9 Citations (Scopus)


INTRODUCTION: Hypertension is an important risk factor for developing cardiovascular diseases. It is more prevalent in the elderly population. Recently updated American and European guidelines recommend treating every elderly patient with hypertension independent of age, starting with a low dose of antihypertensive drugs. However, little information is available on the optimal dosages of antihypertensive drugs to treat the elderly safely. Areas covered: Comorbidities, co-medication and frailty status can alter the clinical outcome of drug treatment and can cause adverse events in the elderly. Also, due to pharmacokinetic and pharmacodynamic changes the interpatient variability when using antihypertensive drugs is considerable. In this review, an overview is given on the extent to which the previously mentioned parameters are changed in elderly patients and what this means for the exposure to antihypertensive medication. Also, recommendations on the starting dose of the most frequently used antihypertensive drugs are given based on literature data. Expert opinion: We believe that recommendations on starting dosages followed by a stepwise increase of dosages will lead to improved blood pressure control and less adverse drug reactions in the elderly patient. This may improve adherence to antihypertensive therapy.

Original languageEnglish
Pages (from-to)287-297
Number of pages11
JournalExpert Opinion on Drug Metabolism & Toxicology
Issue number4
Publication statusPublished - Apr-2019
Externally publishedYes


  • Age Factors
  • Aged
  • Antihypertensive Agents/administration & dosage
  • Blood Pressure/drug effects
  • Dose-Response Relationship, Drug
  • Frail Elderly
  • Frailty
  • Humans
  • Hypertension/complications
  • Medication Adherence
  • Practice Guidelines as Topic
  • Prevalence
  • Risk Factors

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