III. CARDIOVASCULAR THERAPY IN THE ELDERLY
In a randomized study of 87 patients older than 75 with acute myocardial infarction, the composite of death, reinfarction, or stroke at 30 days occurred in 4 (9%) patients in the percutaneous intervention (PCI) group as compared with 12 (29%) in the patients receiving streptokinase intravenously ( p ¼ 0.01). Patients older than 75 years of age with acute myocardial infarction or unstable angina obtain beneficial results with placement of a stent in the culprit coronary artery, blocked by atheroma and thrombosis.
C. Beta-Blocker Therapy
Beta-adrenergic blocking drugs, beta-blockers, have proven beneficial and save lives in patients with acute myocardial infarction regardless of age. Some caution is required because the elderly over the age of 75 may have disease of the sinus node and slow heart rates may occur if the dose of the beta-blocking drug is excessive. Small doses of these agents are also beneficial in the elderly patient with heart failure angina, atrial fibrillation, and hyperten¬sion. In the elderly hepertensive patient, a standing blood pressure should always be taken to doucment postural hypotension caused by vasodilatory anti-hypertensive agents. Beta-adrenergic blockers do not cause postural hypotension.