Hypertension Management and Early Morning Risk in Older Patients

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

Yves Lacourcière, MD, FRCP, Hypertension Research Unit, CHUL du CHUQ, Laval University, QC.

There are many reasons why gaining control over high blood pressure (BP) in older patients is desirable. When choosing an antihypertensive agent for older patients, physicians should seek a drug that sustains BP control, especially in the last six hours of the dosing interval or if a dose is missed. Agents with a long duration of action that inhibit the renin-angiotensin system (RAS) are likely to be more useful in controlling the early-morning surges in norepinephrine that have been linked to target organ damage and stroke, particularly in older patients.

Key words: hypertension, renin-angiotensin, angiotensin-receptor blockers, norepinephrine, peroxisome proliferator-activated receptor (PPAR).