Therapeutic considerations in the elderly hypertensive. The role of calcium channel blockers. Hypertension is an extremely common problem in the elderly. The optimum antihypertensive agent to use in this population is not certain. In this paper, the factors influencing the choice of antihypertensive therapy are reviewed. They include efficacy, safety, comorbidity, utility in special populations, drug interaction, dosage schedule, cost, the mechanisms of action of the drug, and the pathophysiology of the patient's hypertension. Calcium channel blockers are effective and safe in the elderly. They improve other conditions frequently seen in that population and, with the exception of cardiac conduction abnormalities associated with some calcium channel blockers, do not adversely affect other comorbid diseases. They work well together with other antihypertensives and as vasodilators, they may be specifically appropriate in elderly hypertensives, whose hypertension is associated with reduced cardiac output and increased peripheral vascular resistance. Once- and twice-a-day preparations are available to foster compliance, but calcium channel blockers are expensive. 