Knowledge of altered drug pharmacodynamics and pharmacokinetics in the elderly is critical for appropriate treatment of congestive heart failure in the elderly.

Absorption, metabolism, and excretion of drugs used to treat CHF may be significantly altered both by disease (including CHF) and by age. Drug pharmacodynamics may also be altered by age and disease either directly or indirectly. For example, older people have poor defenses against hypotension. Thus, the pharmacodynamic effect of ACE inhibitors on blood pressure may be exaggerated. The addition of other drugs with hypotensive potential will further increase the risk of clinically significant hypotension.

Many drugs given at doses usual for younger patients will best be given in much lower loading and maintenance doses. Increases in drug dosage should be accomplished slowly - thus, the useful adage "START LOW AND GO SLOW."