Beta blockers also tend to worsen wide pulse pressure.
Combining ACE (angiotensin-converting enzyme) inhibitors, such as Lotensin or Vasotec, and ARBs (angiotensin-receptor blockers), such as Diovan or Benicar, is also risky in most older patients — research shows the combination increases the risk of kidney failure and death. These should be used together only for a particular form of systolic high blood pressure related to heart valve defects.
Diuretics, commonly known as "water pills," have been around for many years and have been proven safe and effective time and again. "Diuretics are really the cornerstone of hypertension treatment," says Weintraub.
While some experts prefer using a single agent at a dose high enough to bring the numbers into line, others favor a combination — a diuretic paired with an ACE inhibitor, for example, or a diuretic combined with a CCB (calcium channel blocker). Several of the most common pairings now come in combination pill forms, which cut down on the number of pills needed — an important advantage for anyone taking multiple medications.
Recent findings suggest that CCBs may offer a special advantage for older patients. Researchers have long assumed that controlling high blood pressure would lower the risk of memory problems and dementia in older people. But few studies found any significant benefit. Last year, however, in a study of 375 hypertensive patients 60 and older, researchers at Nancy University Hospital in France reported that people on CCBs showed improvement in memory scores. By contrast, those who took other types of drugs for their high blood pressure showed no memory gains.
Whatever your doctor prescribes, chances are your regimen will need to be adjusted over time. And even though you may need to take medication, researchers all agree that it's important to follow the familiar advice: minimize salt intake, eat plenty of fruits and vegetables, maintain a healthy weight and be as physically active as possible.
"All of those changes can mean you can get by on less medication, which means fewer side effects," says Weintraub. "And in many ways besides lowering blood pressure, you'll be a lot healthier."
Peter Jaret is a frequent contributor to AARP. He has written seven books, most recently “Nurse: A World of Care.”