International Journal of Molecular Medical Science, 2025, Vol.15, No.5, 235-243 http://medscipublisher.com/index.php/ijmms 241 6.3 Reasonable combined treatment strategies For most elderly patients, using only one drug for treatment will not bring blood pressure down to the ideal level and will not achieve the best protective effect on the kidneys. Combination therapy has become a relatively commonly used treatment approach. Clinical guidelines recommend the use of ACEI or ARB in combination with calcium channel blockers (CCB) or thiazide diuretics, which can enhance the antihypertensive effect and reduce the occurrence of side effects (Mhmndal et al., 2025). However, it is generally not recommended to use both ACEI and ARB for dual inhibition simultaneously, as this approach may increase the risk of hyperkalemia and does not offer significant additional benefits for improving renal function (Zhang et al., 2020). Recent studies have shown that for patients with diabetes mellitus complicated with hypertension, the combination of sodium-glucose cotransporter 2 (SGLT2) inhibitors with ACEI/ARB can bring more benefits in improving renal function and controlling blood pressure, without significantly increasing adverse events (Tian et al., 2021). Therefore, when formulating specific treatment plans, personalized choices should be made in combination with the actual situations such as patients' complications and responses to drugs, so as to better exert the positive role of ACEI/ARB in the treatment of elderly hypertension (Alcocer et al., 2023). 7 Future Research Directions and Clinical Significance Early administration of ACEI or ARB to elderly patients with hypertension is of great significance in preventing the aggravation of chronic kidney disease (CKD) and reducing the risk of cardiovascular diseases. Although clinical guidelines strongly recommend such drugs, there are still problems in their actual use, especially for early-stage CKD patients or elderly patients who are not particularly old, as the number of people using these drugs is relatively small. This indicates that the actual practice of seeking medical treatment is different from the guidelines supported by evidence. It is necessary to enhance the publicity and education for doctors and patients to improve it. Early detection of hypertension and proteinuria in the elderly and active treatment can maximize the protective effect of ACEI/ARB on the kidneys, thereby improving the long-term health of patients. It is necessary to promote educational programs and systematic intervention measures, and encourage doctors to administer ACEI/ARB to patients as early as possible, especially for high-risk groups. At the same time, raising everyone's awareness of the early and continuous control of blood pressure and regularly checking for possible uncomfortable reactions can help solve problems in treatment and enable more elderly patients to receive scientific and standardized treatment. The physical conditions of elderly patients vary quite a lot. Whether they have other concurrent diseases, the severity of chronic kidney disease, and their responses to medication are all different. Therefore, it is very important to formulate a treatment plan that suits the individual. The latest research shows that setting individualized blood pressure control targets for patients based on factors such as the stage of chronic kidney disease, the amount of urine protein, cardiovascular risk, and drug tolerance can help better protect kidney and cardiovascular functions. Time therapy is a relatively new form of treatment. Adjusting the time of taking medicine according to the changes in blood pressure throughout the day can enhance the effect of lowering blood pressure. However, the most suitable solution for it still needs further verification. With the continuous advancement of precision medicine, in the future, using pharmacogenomics and specific biomarkers to guide treatment is expected to help doctors more accurately select ACEI or ARB for patients, which can improve treatment outcomes and reduce adverse reactions. Future research should focus on identifying biological indicators that can predict the efficacy and side effects of drugs, and developing intelligent clinical assistance systems to help doctors formulate more accurate and personalized treatment plans for each patient. There are still some deficiencies in the research on the treatment of elderly CKD patients with ACEI/ARB, such as short follow-up observation period, insufficient number of patients studied, and no clinical trials directly comparing ACEI, ARB and other antihypertensive drugs. Larger-scale and longer-term randomized controlled studies are needed in the future to comprehensively evaluate the efficacy, safety and best combination therapy of ACEI/ARB, especially for elderly CKD patients with different severity levels. At the same time, further research should be conducted on the potential benefits of using ACEI/ARB in combination with SGLT2 inhibitors or other
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