Isolated systolic hypertension is a risk factor for stroke in older individuals. Drugs that can be safely used in the older patient to treat this condition include all of the following EXCEPT:

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All of the classes of drugs listed are antihypertensive agents. All of them lower blood pressure. However drugs that act in the central nervous system have a low therapeutic index and may be poorly tolerated or harmful to the older patient. They may contribute to alterations in consciousness, excessive sedation, falls, dry mouth, and constipation among other adverse drug reactions. Beta blockers and thiazide diuretics are well proven to be safe and effective in treating isolated systolic hypertension in older patients. Beta blockers may sometimes cause bradycardia, heart blocks, or they may exacerbate reactive airways disease. When thiazide diuretics are used, serum chemistries should be monitored periodically because of the risk of hypokalemia, hyponatremia, or dehydration. ACE inhibitors are also generally safe drugs, although patients who take them should also have serum chemistries monitored from time to time. A common side effect of ACE inhibition is a nagging, nonproductive cough.

Isolated Systolic Hypertension Is a Risk Factor for Stroke in Older