Selecting Initial Antihypertensive Therapy for Older Adults

Norm Campbell, MD, FRCPC, Departments of Medicine, Community Health Sciences, and Pharmacology and Therapeutics, University of Calgary, Calgary; Libin Cardiovascular Institute, Calgary, AB.
Sailesh Mohan, MD, MPH, Departments of Medicine, Community Health Sciences, and Pharmacology and Therapeutics, University of Calgary, Calgary; Libin Cardiovascular Institute, Calgary, AB.

As over 9 in 10 older adults will develop hypertension, it is important for clinicians to routinely assess blood pressure. It is as important to treat hypertension in older adults as it is in younger people. In general, select a low-dose diuretic. Beta-blockers are not as effective at preventing stroke as other major antihypertensive drug classes. Specific indications for drug classes are provided. Target the blood pressure levels to <140/90 mmHg in general, <130/80 mmHg in people with diabetes or chronic kidney disease, and focus on systolic blood pressure control. If blood pressure control is not achieved using a moderate dose of your initial selection, add a second antihypertensive drug.
Key words: hypertension, antihypertensive drugs, pharmacotherapy, cardiovascular disease, stroke.

CME: Stepwise Approach to the Treatment of Diabetes in the Older Adult

The accredited CME learning activity based on this article is offered under the auspices of the CE department of the University of Toronto. Participating physicians are entitled to one (1) MAINPRO-M1 credit by completing this program, found online at www.geriatricsandaging.ca/cme.htm

Diabetes mellitus (DM) is a very common condition in the older population. The disease may interact with other medical conditions that increase the degree of frailty in aging adults. Nonpharmacological and pharmacological interventions are the usual steps in managing of DM. In this article, a stepwise treatment strategy will be suggested after a review of the pertinent literature.

Key words: diabetes mellitus, older adult, diet, exercise, pharmacotherapy.

Daniel Tessier MD, MSc, Head of Geriatric Services, Sherbrooke Geriatric University Institute, Sherbrooke, QC.

Age-related Insulin Resistance and Predisposition to Diabetes

Daniel Tessier, MD, FRCPC, Professor, Head of Geriatric Service, Sherbrooke Geriatric University Institute, Sherbrooke University, Sherbrooke, QC.

The concept of insulin resistance is a major field of interest in the medical literature. The basic science research has significantly increased our knowledge of this phenomenon, which has become a silent killer in our society. The main factors involved in insulin resistance are obesity (mainly abdominal), lack of physical activity, loss of muscle mass and secondary diminution in insulin action followed by diabetes mellitus. The changes in lifestyle and diet observed in many older subjects increases the risk of insulin resistance and diabetes. This paper will underline the main elements for primary and secondary prevention of insulin resistance in older adults.
Key words: insulin resistance, older adults, diabetes mellitus, obesity, free fatty acid, pharmacotherapy.