Available drugs, initial and target doses, dose adjustments, and safety in elderly patients
Drugs	Initial dose	Maximum dose	Dose adjustment for elderly patients	Safety in elderly patients
Captopril	6.25 mg 3×/day	50 mg 3×/day	None	Increase in orthostatic hypotension Take before bedtime Decrease diuretics
Enalapril	2.5 mg 2×/day	10–20 mg 2×/day	None	More susceptible to renal dysfunction
Lisinopril	2.5–5.0 mg 1×/day	20–40 mg 1×/day	None	Avoid use of NHAI drugs
Perindopril	2.0 mg 1×/day	8,0–16 mg 1×/day	None
Ramipril	1.25–2.5 mg 1×/day	10 mg 1×/day	Adjust according to renal function
Candesartan	4.0–8.0 mg 1×/day	32 mg	None, but elevated AUC and Cmax	Similar to that of ACEI
Losartan	25 mg 1×/day	50–100 mg	None
Valsartan	40 mg 2×/day	320 mg	None
Bisoprolol	1.25 mg 1×/day	10 mg 1×/day		Water retention: - Monitor weight daily - Adjust diuretic dosage Risk of hypotension and bradycardia: - Start with a low dose and increase progressively - Adequate hydration Increased fatigue: - Improves over time - Consider comorbidities  anemia
Carvedilol	3.12 5mg 2×/day	50 mg/day	None
Metoprolol succinate	12.5–25 mg	200 mg/day	None
Nebivolol	1.25 mg	10 mg	None
Spironolactone	12.5–25 mg	25–50 mg	None	Increased risk of hyperkalemia and renal dysfunction Monitor K and creatinine
Furosemide	20–40 mg/day 1 or 2×/day	600 mg (usual 40–240 mg/day)	Start 20 mg/day	Frequent monitoring Increased risk of alterations in water balance and electrolyte disturbances
Bumetanide	0.5–1 mg 1 or 2×/day	10 mg Usual (1–5 mg/day)	None	Frequent monitoring Increased risk of alterations in water balance and electrolyte disturbances
Hydrochlorothiazide	25 mg	200 mg/day Usual (12.5–100 mg/day)	Start 12.5 mg–25 mg	Monitor fluid volume and electrolyte status
Chlorthalidone	12.5–25 mg	100 mg	None	Monitor fluid volume and electrolyte status

ACEI: angiotensin converting enzyme inhibitors; AUC: area under curve; NHAI: non-hormonal anti-inflammatory.