Benzodiazepine as an Antihypertensive Agent on Adult and Elderly: A Review

The relationship between benzodiazepine and hypertension has long been known and well-documented, but, the character of γ-aminobutyric acid (GABA)-A and GABA-like peripheral receptors (PBR complexes) in blood pressure regulation is intricate. However, this ‘literature review’-facilitated argumentative paper went through an inclusive view into past studies, meta-analyses and case studies that had underlined the potential antihypertensive roles of benzodiazepines, which exert their antihypertensive mechanisms through GABA-A receptors in the CNS alongside PNS and GABA like receptors (PBR Complexes) in vasoactive smooth muscles and blood vessels via “tempering anion channels (Ca++ channels)” as well as “modulating glucocorticoid synthesis” in many parts including suprarenal gland and brain by directly acting on PBR complexes of inner mitochondrial membrane close to voltage-gated anion channels and cholesterol transports along with “exerting adenosine reuptake inhibitor” activities throughout the CVS including coronary vessels that could potentially prevent morbidity and CVDs in hypertensive elderly. Despite benzodiazepine’s antihypertensive effects on multiple cardiovascular clinical incidences and emergencies including their use as a prophylaxis for hypertensive elderly and adult, very few past studies were found to have addressed benzodiazepine’s antihypertensive action, that remains a critical limitation and challenge to this paper, as its motto is to find out the correlation between benzodiazepine and their CVS effects alongside the risks and benefits of benzodiazepine in hypertensive patients, in particular in elderly. Despite the limitations, this paper had reached a conclusion following an argument on findings of past studies, that, certain benzodiazepines could be useful as an antihypertensive agent with or without conventional anti-HTN. However, in case of elderly, often antidepressants are prescribed in patients with hypertension despite their increasing risks, but use of benzodiazepines in elderly could decrease a number of risks and therefore it could be said that benzodiazepines are comparatively safer to use in elderly as an antihypertensive, while before introducing antidepressants, the patients’ history should provide enough evidences that the risks such as suicidal ideation, mania and exacerbation of underlying psychological disorders might not be outweighing the benefits. Alongside this, it could also be said that the long- and centrally-acting benzodiazepines such as Diazepam and Clonazepam act better to lower mean BP in both adults and elderly, but those exerting both peripheral and central actions to reduce mean BP such as intermediate-acting bromazepam, showed better response in elderly. However, further researches ought to be conducted to reach a comprehensive resolution.


Introduction
Background: The aim of this "literature review"-based argumentative study is to find out the correlation between benzodiazepine and its impact on patients with HTN with or without underlying psychotic clinical conditions, as benzodiazepines are often being prescribed as a prophylaxis or treatment of essential hypertension in combination with typical anti-hypertensives such as ACE inhibitors, Beta blocker, Calcium channel blocker and Diuretics among others. Aside from that, benzodiazepines are frequently used as a prophylaxis or a treatment modality in elderly patients who could be exempted from the risks of fall.
Besides, long acting benzodiazepines such as Diazepam, Clonazepam and Lorazepam are thought to be exerting their functions through CNS and work efficiently irrespective of age and sex, while intermediate acting benzodiazepines such as bromazepam or alprazolam are believed to be more effective in elderly to lower blood pressure and both of them act on both CNS and PNS. Short-acting benzodiazepines such as midazolam are effective in emergencies such as hypertensive crisis, but have had little or no roles in maintenance of a low blood pressure for a longer duration. Several meta-analyses of past studies have found that the elderly hypertensive patients being treated with benzodiazepines alongside conventional anti-HTN would lessen the risks of developing CVDs or related morbidities and hospitalization. Furthermore, hypertensive patients who already have experienced an episode of ischemia would less likely to require hospitalization due to CVDs following long-term combination therapy of intermediate-acting benzodiazepines alongside traditional anti-hypertensive agents.

History and origin of benzodiazepines
Benzodiazepines' origin is rooted back in the 1955s when Leo Sternbach had synthesized the first benzodiazepine, chlordiazepoxide, during working on tranquilizers in Hoffmann-La Roche. However, initial findings of the drug were disappointing and Leo Sternbach had other projects in mind, therefore, he left the work on Chlordiazepoxide. Two years later, during cleaning the lab, Sternbach's co-worker Earl Reeder had found a "nicely crystalline" compound which had actually been a left-over of Sternbach's initial project. Without much expectation, the compound, later named chlordiazepoxide, had been trialed on animals and the compound had shown a strong sedative, anti-convulsive and muscle relaxant impact, thus leading to a quicker introduction into the market in 1960s under the brand name Librium. After that, diazepam was marketed in 1963 and after introduction of two potent benzodiazepines, prescription of barbiturates had been depreciated by a substantial scale. However, according to Shorter, E., (2005), in the 1980s, concerns rose over the benzodiazepines' dependence, which later led to the world's largest-ever class-action lawsuit that alleged drugmakers in the UK of withholding information about benzodiazepines' dependence potential. However, consultant psychiatrists, expert witnesses, had shown a conflict of interest and the £30 million lawsuit had botched to reach a conclusion, thus reducing the chances of yielding a result in such lawsuits relating to newer benzodiazepines in future given the costs of a legal proceedings and uncertainties about finding a conclusive verdict in the court [Shorter, E., 2005].

A prelude to benzodiazepines
Benzodiazepines are a class of psychoactive drugs, a chemical agent that alters nervous system functions and leads to an altered perception, mood, cognition, behavior, consciousness. Benzodiazepines' basic chemical structure contains a fusion of a benzene ring and a diazepine ring.
As beforementioned, benzodiazepines exert their effects by enhancing the impact of neurotransmitter

Understanding relationship between benzodiazepines and GABA-A and GABA-like receptors (PBR Complexes)
In order to understand the correlation between benzodiazepine and its cardiovascular effects, roles of GABA (gamma amino butyric acid) neurotransmitters in regulating blood pressure should be precisely elaborated. Benzodiazepines exerts their actions by enhancing the effect of neurotransmitter GABA, the chief inhibitory neurotransmitter in central nervous system whose principal role is to reduce neuronal excitability. At GABA-A receptor, a ligand-gated ion channel upon opening of which the permeability of chloride ion and to a lesser extent bicarbonate ion, increase. Hence, activation of GABA-A receptor will lead to an influx of chloride into the cell, reducing the chance of a successful action potential in postsynaptic neurons, thus inducing an inhibitory effect on neurotransmission. GABA-A-mediated IPSP (Inhibitory postsynaptic potential) in normal physiological condition is -70mv and GABA-B (a G-protein coupled receptor for GABA where potassium ion concentration induces hyperpolarization at the end of an action potential) is -100mv, while a depolarization between +10 mv to +15 mv is sufficient to result a firing and leading to a spike and generation of excitatory effects as stated by Barrett  After binding to benzodiazepine receptors, the benzodiazepines receptors are locked by benzodiazepine ligands in such a formation that has a greater affinity for GABA neurotransmitters, which eventually accelerates the frequency at which chloride ion channels are opened and hyperpolarization of the postsynaptic membrane takes place.

How benzodiazepines lower blood pressure
Since benzodiazepine induces their actions via enhancing the effects of several isoforms of GABA, the most potent inhibitory neurotransmitter in central nervous system, GABA pathway activation in central and peripheral nervous system and its pathophysiological mechanism should be considered for benzodiazepine's anti-hypertensive actions.
GABA receptor chiefly has two sub-types such as ionotropic GABA-A receptors as well as metabotropic Here is a depiction of anatomical distribution of GABA receptor types in brain and in the body, though a description of GABA receptor isoforms is beyond the scope and opportunity of this paper.  Aside from the CNS, GABA has been profusely found in other peripheral tissues such as intestine, stomach, fallopian tube, uterus, ovaries, kidneys, bladder, testes, lungs and liver, however, at a much lower extent than those of CNS. Beyond the brain, GABA is also formulated in the beta cells of pancreas alongside insulin, thereby exerting a potential role in diabetic patients.

Literature review
Although the roles of benzodiazepine signaling a blood pressure regulation through GABA activation is complex, multiple previous studies, case studies and meta-analyses have reported that an induction of benzodiazepine could significantly reduce blood pressure, heart rate alongside renal sympathetic nerve activities. Other studies had revealed that the benzodiazepine-induced activities in different areas of brain could effectively impact neural regulation of blood pressure through inhibiting sympathomimetic signals as beforementioned and a stimulation of GABA-A receptors in posterior hypothalamus would dramatically decrease blood pressure in hypertensive subjects, according to Antonaccio and Taylor (1977) [Antonaccio and Taylor, 1977].
Being a "literature review"-based argumentative paper, this study will have had a probing view on past studies, literature reviews, meta-analyses and case studies underlining the anti-hypertensive role of benzodiazepines in both adult and elderly. According to the findings of previous studies, an elaborative argument will be conducted in order to reach an incisive resolution regarding correlations between benzodiazepines and hypertension alongside the risks and benefits of using benzodiazepine as a prophylaxis or treatment with or without conventional anti-hypertensive drugs.
Albeit, essential hypertensions frequently require a combination therapy, patients who have been in risk of developing hypertension with frequent surge in blood pressure above normal are often prescribed with a benzodiazepine or antidepressants in a non-invasive approach.

Roles of benzodiazepines on cardiovascular system & vasoactive smooth muscles and their anti-hypertensive effects
benzodiazepine-induced GABA receptors' activation has an immense effect on spike timing, neuronal rhythm alongside the activity patterns of electro-chemical regulation in neuronal circuits. Apart from CNS effects, the benzodiazepines have had a substantial scale of impact on CVS as GABA-A receptors and GABA-like PBR Complexes could impact both electrical as well as hemodynamic parameters. DiMicco and Gale found in 1979 that benzodiazepine could affect the CNS-regulated chronotropic impacts on heart through nucleus ambiguous, that had been found to be affecting the vagal tones and heart rates as well [DiMicco and Gale, 1979]. Previous studies also had found that the benzodiazepines could exert direct or indirect impact on cardiac rates and reduce blood pressure by directly acting on of endothelium as noted by Apart from hypertensive emergencies, benzodiazepines could be effective in maintaining lower blood pressure level in long-term benzodiazepine treatment as found in a retrospective study conducted by Mendelson et al., (2018). It was also found that the patients who had been treated with more than 3 months with benzodiazepines showed better response to essential hypertension than those who had never been Besides, past studies had revealed that people above 60 years of age had shown an independent association between lower blood pressure and benzodiazepine treatment combined with antihypertensive drugs, while the elderly patient group receiving benzodiazepine treatment in combination with conventional antihypertensive drug had shown to have a better maintenance of lower systolic and diastolic pressure than those who were being treated with only conventional anti-hypertensive drugs. This could be caused by a tolerance developed against long-term antihypertensive drugs, while patients with anxiety associated hypertension could have responded better to a benzodiazepine treatment as suggested by Mendelson et al., [Mendelson et al., 2018] Moreover, past meta-analyses also had reported that the lowering of blood pressure in use of benzodiazepines had not been associated to age, while a long-term benzodiazepine treatment could stem a better response to hypertensive patients of all ages. Hypertensive patients above 58 years of age being treated with benzodiazepines had low chances of developing cardiovascular diseases and associated morbidity as well as hospitalizations.
According to a retrospective study conducted by Wu Ck et al., (2014), a patient group who had been followed just a notch shy of 5 years after suffering from an ischemic attack at least once in their lives and had been treated with benzodiazepine, had found to have lower rate of mortality and hospitalization due to Another potential negative impact of benzodiazepine use in elderly has been there inappropriate use which could increase the risks of paradoxical hypertension instead lowering blood pressures as not all benzodiazepines are identically effective to decrease blood pressure, for instance, long-term use of long-acting benzodiazepines like of diazepam could be beneficial in maintenance of a lower blood pressure and short-acting benzodiazepine such as midazolam, could be more effective in hypertensive emergencies.

Nonetheless, intermediate acting benzodiazepines like of bromazepam alongside other atypical
benzodiazepines are found to have paradoxical impact on blood pressure, which will be elaborated in the later part of this literature review. In tandem, an indiscriminate and without prescription use of benzodiazepine in elderly, which usually is associated with an increased chance of abuse, must be prevented.

Benzodiazepine as a vasodilator
Several GABA-like peripheral benzodiazepine receptor ligands, often called as PBR complexes, are copious in the cardiovascular system, CVS lumens, platelets, erythrocytes, lymphocytes, mononuclear cell,

Benzodiazepine as an adenosine reuptake inhibitor
Benzodiazepines acting as an active adenosine reuptake inhibitor could lower blood pressure through

Role of benzodiazepines as a renal sympatholytic, on cortisol and steroidogenesis
Besides, benzodiazepines usually act through 18-kDa PBR protein which is a mitochondrial contact site of anion channel, and disrupt hormonal response to cholesterol transport and reduce circulatory glucocorticoid level, eventually lowering blood pressure.
Benzodiazepines could act as an active ingredient to lower blood pressure by exerting their actions through increasing cholesterol concentration in steroid producing cells' cytoplasm such as suprarenal gland and brain among others.
It is known that a benzodiazepine-mediated inhibition of PBR complexes present at inner mitochondrial membrane of the cytoplasm of glucocorticoid producing cells such as adrenal glands could impact steroid synthesis by affecting cholesterol transport.
In factuality, the rate at which steroid is synthesized, has been mediated by hormone-induced and constitutive signals. Nonetheless, according to Brown and Papadopoulos (2001), an inhibitory effect on PBR Complexes in the microenvironment initiated by benzodiazepines' actions such as selective disruption of PBR Complexes in steroidogenic cells, could regulate the rate at which cholesterol is inserted into the mitochondrial membrane through a cholesterol pore, thereby controlling the rate at which glucocorticoids are produced [Brown and Papadopoulos, 2001].

Use of Different benzodiazepines as anti-hypertensive agent
When it comes to using different classes of benzodiazepines in treatment of hypertension, Lasagna, L., had been quoted saying about four and a half decades earlier that there had been significant reasons to believe that benzodiazepine could not only be used as anxiolytic, but also those might have substantial role in treating complaints related to cardiovascular system and GIT in addition to tension headache alongside hypochondriac pain [Lasagna, L., 1977].

Case studies elaborating benzodiazepines' anti-HTN effect
Despite a relative lack of available research works on benzodiazepine uses as an antihypertensive agent which remains a limitation of this argumentative paper as beforementioned, a number of meta-analyses and studies of previous clinical cases had reported that a general cohort in clinical practice has been a frequent use of benzodiazepine in combination with anti-hypertensives in patients with essential hypertension, mild or benign hypertension alongside hypertension with underlying psychological disorders.

Reduction of BP irrespective of age and sex with long-acting benzodiazepines such as diazepam
when it comes to using benzodiazepines with or without antihypertensive, Divac

Use of benzodiazepine as a prophylaxis to hypertension
Given benzodiazepines' efficacy in lowering blood pressure with or without traditional anti-HTN in emergencies and long-acting and intermediate-acting benzodiazepines' role in reduction of BP in essential hypertension in combination with anti-hypertensive agents, it could be said indubitably that benzodiazepines have had an active role in controlling blood pressure irrespective of their central or peripheral mechanism of action.
Previous studies mentioned in the literature review suggested that certain benzodiazepines could be used as primary or secondary prophylaxis of certain medical conditions including cardiovascular diseases such as hypertension, while it was also stressed that possible action of benzodiazepines on cortisol or stress hormones, antiplatelet activation factor or an alteration in parasympathetic tone could be investigated further for benzodiazepine's non-psychiatric usages.
Besides, when combined with benzodiazepines, anti-HTN treatments had shown to have lower incidences of CVDs or associated risks and hospitalization, while patients with risk of developing HTN or with benign HTN, benzodiazepines could be effective, hence establishing benzodiazepines' role as an effective prophylaxis of hypertension along with cardiovascular diseases. Lapane et al., (1995), had found a strong correlation between ischemic cardiac events and use of antidepressants [Lapane et al., 1995], while Krantz et al. said in 2009 that, although, baseline anxiolytic such as benzodiazepines were not found to be increasing the risks of CVD events, but the use of antidepressants had been associated with CVD events in woman and an increased risk of ischemic heart disease related mortality in elderly men, apparently due to an accumulation of endothelial lipid, higher blood cholesterol level, underlying Diabetes Mellitus, fat deposition and increased appetite despite a lowering of platelet aggregation, which are very common in use of both TCA and non-TCA antidepressants [Krantz et al., 2009]. According to a study conducted by Wu

Research methodology
Since this has been a "literature review"-based argumentative research, past studies and meta-analysis of past research works alongside case studies on benzodiazepines' use on hypertension have been discussed with an incisive approach, while the literature review also had highlighted multiple case studies and metaanalysis of previous works related to benzodiazepines' efficaciousness on elderly alongside the drug classes' pragmatism in lowering the risk of CVDs, related hospitalization and morbidity. However, the literature review section had underscored the benefits of using benzodiazepine as an anti-HTN irrespective of the hypertensive patient groups' age and sex. Considering the comely that benzodiazepines could yield in quality of life in hypertensive elderly in use of benzodiazepines alongside traditional anti-hypertensive agents, this review will look at the benefits of benzodiazepines benefits in elderly. Besides, this research also had looked at past case studies underscoring potential risks of using antidepressants in patients with hypertension.

Data collection and analysis
Having been a literature review-based argumentative paper, in order to identify the benefits of benzodiazepines in hypertensive elderly and adults alongside patients with benign hypertension, this paper had taken a comprehensive approach to analyze the past works. In order to reach an inclusive resolution on whether the benefits of use of benzodiazepines in elderly and adult could outweigh the risks, an elaborative argument will take place based on the findings of the past research works, while discoveries of the arguments will be disbursed in the recommendation.

Results, arguments and recommendations
When it comes down to an evaluation of benzodiazepine's use as an anti-hypertensive on elderly and adult, this literature review-based argumentative paper had looked into past studies in order to have a precise understanding on relationship between benzodiazepine and its CVS and CNS effects. It was discussed how benzodiazepines downsize mean blood pressure alongside their elaborate mechanism of action which is exerted by an enhancement of the GABA-A neurotransmitter's inhibitory actions and PBR complexes in the CNS and PNS. The Literature review section has looked into past studies to find out how benzodiazepine could affect CVS, CNS, vasoactive smooth muscles and steroidogenesis while exerting a renal sympatholytic action alongside acting as a vasodilator. Different benzodiazepines impact on blood pressure was discussed to reach a conclusive resolution on whether the benefits of use of benzodiazepine in hypertensive adults and elderly with or without the use of conventional anti-hypertensive drugs could offset the risks.
This particular section will yield a synopsis of the findings of past studies and meta-analysis of researches on benzodiazepines' impact on blood pressure, while according to the synopsis, an argument will be conducted.

Findings
In terms of benzodiazepines' CVS effect, GABA-A receptor could act both centrally and peripherally as GABA-A receptors in many parts of the brain such as hypothalamus, ventrolateral medulla and amygdala nucleus among others could take part in modulating CVS activities while decreasing blood pressure and PBR complexes in blood vessels could dilate them, effectively suppress sympathetic excitement at nerve ending, and sometimes act directly on striatal cardiac muscles and coronary arteries by acting as an adenosine reuptake inhibitor, eventually increasing concentration of adenosine in microstructural environment while helping depreciate the risks of CVDs in elderly [33 adenosine]. Besides, studies had found that stimulus on GABA-A receptors in posterior hypothalamus could dramatically reduce blood pressure.
Almost all benzodiazepines could affect the CNS-regulated chronotropic impact on heart through nucleus ambiguous, which has found to be linked with parasympathetic vagal tones, and play a pivotal part on spike timing, neuronal rhythm and the activity patterns of electro-chemical regulation in neuronal circuits, though it is also found that benzodiazepines could exert direct or indirect impact on cardiac rates and reduce blood pressure and change other hemodynamic parameters by dilating blood vessels and exceling renal sympatholytic activities.
This goes without saying that the benzodiazepines could effectively lower blood pressure, in particular systolic blood pressure and thereby reducing mean blood pressure, however, questions raise on divergences of modalities on benzodiazepines according to their duration of action and chemical structure.
Addressing the issue, it has been found that short-acting benzodiazepines such as midazolam potentiate their antihypertensive actions through vasodilation, which might be a response to voltage gated Ca ++ channels in the neurocytes of blood vessels and as a weak adenosine reuptake inhibitor. Even in a study conducted on a mouse with precontracted aortic ring, midazolam was found to have a reversible vasodilatory effect at low doses. Besides, in a study conducted on a human subject, TPSO, a peripheral GABA-A-like receptor that acts similar to GABA-A in CNS, had found to have prompted myocardial response to ischemia and might have had a role in endothelial response of benzodiazepines. In acute cases, such as hypertensive crisis and other life-threatening sympathomimetic events, midazolam as well as longacting benzodiazepines were found to be as effective as ACE inhibitors.
When it comes to intermediate-acting benzodiazepines such as bromazepam or alprazolam, those benzodiazepines were found to have a profound impact on maintaining a lower blood pressure in both adult and elderly in combination with a typical anti-hypertensive agent. However, those drugs acted better in elderly to maintain a low blood pressure level, in treatment of labile hypertension and to decrease the risks of cardiovascular diseases or cardiovascular disease-related hospitalizations. A meta-analysis of past studies also had found that the intermediate-acting benzodiazepines in combination with traditional antihypertensives could decrease the rate of cardiovascular disease-associated morbidity or hospitalization in elderly patients aged above 65 who had experienced an ischemic attack at least once in their lives.
Besides, although, a lowering of blood pressure in benzodiazepine usage had not been entirely related to age and sex, but, both long-acting and intermediate-acting benzodiazepines in elderly patients aged above 58 with hypertension and anxiety-or depression-associated HTN acted better than those with only conventional anti-HTN treatment.
Long-acting antidepressants alone could have significant role in decreasing blood pressure regardless of their actions in CNS and PNS, as previous studies and meta-analysis had found that an oral administration of as little as 5mg diazepam, could to a significant fall in both systolic and mean blood pressure.
Sympathomimetic activities in smooth muscles were also diminished. However, long-acting benzodiazepines such as diazepam did not lead to a decrease in heart rate, suggesting that the long-acting benzodiazepines might have exerted their hypotensive effects by acting on CNS. Lorazepam, which is used as an anti-convulsant in neonates and children, has been effective in decreasing anxiety-associated hypertension following a dose regimen of 3mg/day for 4 weeks.
Past case studies had revealed that long-acting benzodiazepines such as diazepam could reduce effectively irrespective of age and sex, while elderly hypertensive patients usually respond better in long-term benzodiazepine therapy. Clonazepam has found to be effective in treating patients suffering from labile hypertension and anxiety mediated hypertension. It has also been unveiled that the benzodiazepines could reduce the risk of CVDs and hospitalization in elderly hypertensives in combination with traditional antihypertensives better than those taking only traditional anti-hypertensives. Besides, in treating patients with hypertensive crisis, midazolam had shown better efficacy than anti-hypertensive agents such as captopril, however, a combination of midazolam and captopril has been found be to be more efficacious in decreasing mean blood pressure.
In terms of benzodiazepine-associated risks in hypertensive elderly, inappropriate or erratic use of benzodiazepines could lead to paradoxical episodes of hypertension and hypotension. Concomitantly, use of benzodiazepines in both adults and elderly are often associated with abuse. After prescribing benzodiazepines, patients with prior history of substance abuse, memory deficits and suicidal ideation should be monitored. Besides, elderly patients who have been in risks of fall due to physical aging or rheumatological clinical conditions among others, should be counselled before prescribing benzodiazepines. Even though, risks of benzodiazepines' use in elderly are much lower than those in use of antidepressants.

Arguments
Aside from benzodiazepines' wide-spread use as an anti-hypertensive with or without in combination of an anti-hypertensive or a prophylaxis to HTN, previous past studies also revealed the benzodiazepine's efficacy in limiting the CVD-related emergencies, morbidities or hospitalization. However, use of benzodiazepines come up with a greater risk in adults and elderly who have a prior history of substance abuse or psychotic disorders such as suicidal ideation. However, with proper monitoring and history-taking before introduction of benzodiazepines could, those risks could be curbed out and thereby the study finds that the roles of benzodiazepines should be contemplated as an effective treatment in reducing blood pressure in both adult and elderly, as a prophylaxis in adult individuals with benign hypertension and as a rational treatment modality to limiting the risk of ischemia or CVDS in hypertensive elderly, as the risks of benzodiazepines treatment in hypertensive adult and elderly could be easily outclassed by their benefits.
However, often antidepressants are used in hypertensive adults in combination with typical anti-HTNs, but past studies had shown those treatment regimens came in with an increased risk of CVDs associate morbidity and CVDs related hospitalization, psychotic events such as suicidal ideation and mania alongside a higher chance of fall.

Conclusion & Recommendation
In conclusion, despite benzodiazepines' representation as a useful tool for limiting the access of hypertensive patients into emergencies, use of all classes of benzodiazepines could not be recommended for long-term use for all age-groups, benzodiazepines might and could be used in treating patients with hypertension in both adults with benign hypertension and elderly depending on their specific clinical condition. Low-to-moderate dose of long-acting or intermediate-acting benzodiazepines could be highly effective in limiting the risks of CVDs in hypertensive elderly, as past studies had found an addition of benzodiazepines in hypertensive patients could decrease the hospitalization with MI, angina, essential hypertension and congestive heart failure. Following conducting a vigorous argument on the findings of this literature review-based argumentative research that addressed benzodiazepines' efficacy in hypertensive elderly and adults to lower blood pressure and to be used as a prophylaxis to hypertension, it could be concluded that benzodiazepine is safer as a prophylaxis/treatment for HTN in elderly with or without presence of psychiatric disorders such as anxiety and depressive disorders among others. However, as antidepressants are widely prescribed in hypertensive elderly despite their gruesome side effects, before prescribing antidepressants, history must show that there has never been any underlying psychiatric disorder. After induction, patients must be monitored regularly for suicidal ideation, violent behavior and mania. Unlike anti-depressants, benzodiazepines are more versatile with low side effects when it comes to CVDs. In long-term anti-hypertensive medication, a benzodiazepine could be added with anti-HTNs to increase efficacy and decrease the risks of myocardial ischemia and alongside other CVDs, while the benefits of benzodiazepines could easily outsmart the associated risks.