No abstract

The effect of withdrawing or continuing anti-hypertensive therapy on orthostatic blood pressure change in elderly hypertensive subjects was examined. Subjects meeting criteria for therapy withdrawal had supine and standing blood pressure measurements taken on treatment, and at 1, 3, 6, 9 and 12 months off treatment whilst receiving standard non-pharmacological advice to lower blood pressure. Subjects not meeting blood pressure criteria for treatment withdrawal or were unwilling to stop treatment had blood pressure measurements taken after 6 and 12 months whilst also receiving non-pharmacological advice. Orthostatic hypotension was defined as a mean systolic blood pressure fall > 20 mmHg on standing from a supine position. Forty-seven subjects (median age 76 years, range 65-84 years) had treatment withdrawn. Thirteen subjects (median age 73 years, range 68-82 years) continued on their treatment. Twelve months after treatment withdrawal there was a significant reduction in the number demonstrating orthostatic hypotension from 11 (23%) to four (11%) (P< 0.05), whilst the group continuing on treatment showed no change. In the withdrawal group those with orthostatic hypotension on treatment (a = 11) were older (79 versus 74 years, P =0.05), had higher prewithdrawal systolic blood pressure (164 ± 21 versus 147 ± 17 mmHg, P = 0.02) compared to those without, although there was no difference in body mass index, gender, number or type of anti-hypertensive drugs taken. In elderly hypertensive subjects withdrawal of anti-hypertensive therapy and institution of non-pharmacological treatment can over several months reduce the prevalence of orthostatic hypotension.

No abstract

In view of the concern regarding the potential risks and (urinary sodium excretion 95 ؎ 36 vs 174 ؎ 40 mmols/24-h, respectively), clinic supine SBP fell by 8 benefits of sodium restriction, the effect on biochemical and orthostatic responses from a moderate reduction in mm Hg (95% CI: 1-15 mm Hg, P Ͻ 0.05) and diastolic BP (DBP) by 1 mm Hg (CI: −3 to 5 mm Hg); there was no sodium intake in elderly persons that is sufficient to lower systolic blood pressure (SBP) was examined. change in total LDL-and HDL-cholesterol and triglyceride levels, serum calcium, phosphate, parathyroid horSeventeen hypertensive subjects aged 65-79 years entered a double-blind randomized placebo controlled mone, glucose, creatinine clearance or urinary albumin excretion rate. Serum urate was significantly higher durcross-over trial of a low sodium diet plus placebo tablets vs a low sodium diet plus sodium tablets (80 ing the low compared to high sodium intake (304 ؎ 56 vs 277 ؎ 44 mols/l). Orthostatic BP responses during mmols/day) each for 5 weeks. At the end of high and low sodium periods, two 24-h urine collections and venous the high and low sodium intakes were unchanged. In summary, after 5 weeks of moderate sodium blood samples were undertaken and supine and standing BPs were recorded. restriction no adverse effects other than an increase in serum urate was seen in elderly hypertensive persons. On the low compared to the high sodium phase