III. CARDIOVASCULAR THERAPY IN THE ELDERLY
D. Calcium Antagonists
The calcium antagonists, or calcium entry blockers, are widely used to treat hypertension. From 1990 to 2002, the World Health Organization (WHO) and the joint national committee for advice on hypertensive treatment in the United States recommended the use of calcium antagonists as first line agents for management of hypertension in the elderly. Their recommendation is illogical and somewhat misguided. These agents are well known to precipitate heart failure and should be used only in elderly patients who have no evidence of left ventricular dysfunction.
An epidemic of heart failure is occurring particularly in the elderly. Calcium antagonists increase the incidence of heart failure in the elderly because the aging heart loses its contractile function and abnormal histologic, anatomic, and biochemical changes occur that increase the risk of heart failure. Fortunately, the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) showed conclusively that the use of a diuretic was more beneficial than calcium antagonists in the prevention of stroke mortality and heart failure. Impor¬tantly, this study showed that the alpha blocker doxazosin caused an increased risk for the development of heart failure and the use of alpha blockers should be curtailed. The result of this study will change recommendations and prescribing habits worldwide.