This study was designed to determine whether blood pressure reduction, per se, causes adverse effects on cognitive and behavioral function in elderly hypertensive patients. Men with mild-to-moderate diastolic hypertension who had passed their 60th birthday were entered into the trial. After a placebo washout period, they were assigned in a randomized, double-blind manner to one of two groups receiving hydrochlorothiazide (either 25 mg once or twice daily or 50 mg once or twice daily). Responders entered a 1-year maintenance period. Nonresponders were randomly assigned to double-blind treatment with hydralazine, methyldopa, metoprolol, or reserpine added to the diuretic therapy. During the placebo and treatment periods, patients underwent a battery of psychometric tests designed to assess cognitive function, motor skills, memory, and affect. A separate questionnaire assessed the patient's ability to perform activities of daily living. A subset of patients blindly being treated with placebo received the same battery of tests as a control for practice effect. The results showed that there was similar improvement on the psychometric tests between those patients whose blood pressure was successfully reduced and the placebo-treated control group. Therefore, the practice effect did not obscure a true deterioration in function. There were no substantive differences between the lower and higher doses of diuretic or among the four drugs added to the diuretic, although there were qualitative differences in side effects. We conclude that blood pressure reduction, per se, does not adversely affect cognitive and behavioral function in elderly hypertensive patients and that antihypertensive treatment is safe and effective in these patients. (Hypertension 1990;15:361-369) E levated blood pressure in elderly patients can be safely and effectively reduced by using either hydrochlorothiazide (HCTZ) alone or, if necessary, by the addition of hydralazine, methyldopa, metoprolol, or reserpine to HCTZ.1 This paper addresses the perception that such blood pressure reduction in elderly patients may be associated with uncomfortable or even disabling side effects. by drug therapy. As part of the study detailed in part I, 1 we performed extensive psychometric testing to determine objectively the effect of treatment on cognitive function, motor skills, and memory. In addition, we assessed changes in affective state and activities of daily living. MethodsThe details of the design for this multicenter trial are presented in part I.1 Briefly, 690 men who had passed their 60th birthday and who met entry criteria for mild-to-moderate hypertension were randomly assigned to treatment with HCTZ (from 25 to 100 mg/day). Patients who achieved goal blood pressure of less than 90 mm Hg and at least a 5 mm Hg decline from baseline entered a 6-month maintenance period. Patients who did not achieve goal blood pressure were randomly assigned to treatment with by guest on May 11, 2018 http://hyper.ahajournals.org/ Downloaded from

Daily maternal neck restraint, whole body restraint, hyperthermia, and ACTH treatment during the last 3rd of gestation had no reliable effect on open-field and cage-emergence behavior in male Sprague-Dawley offspring. Many of these treatments, however, produced considerable maternal pathology and evidence for maternal adrenocorticoid release. Significant litter effects were found for almost every morphological and behavioral measure. Failure to control for the litter variable may account for many previously reported effects of prenatal stress on emotionality in rats. Female rats showed greater activity and less defecation than males on postpubertal open-field and cage emergence tests.

The bracken fern, Pteridium aquilinum, which can form completely homozygous zygotes in a single generation of self-fertilization, has a genetic system that allows the storage and release of genetic variability in spite of this homozygosity. Analysis of the distribution of electrophoretically demonstrable genetic markers demonstrates that this system is based on recombination between duplicated, unlinked loci.

We compared the efficacy and adverse effects of antihypertensive drug regimens in 690 men past age 60 with diastolic blood pressure 90-114 mm Hg and systolic blood pressure less than 240 mm Hg. They received either a low (25-50 mg) or high (50-100 mg) dose of hydrochlorothiazide daily. Of 644 patients who completed the hydrochlorothiazide titration, 375 (58.2%) were responders (diastolic blood pressure <90 and <5 mm Hg below baseline) and 92.8% of these completed a 6-month maintenance period. Blood pressure was reduced from 157.6/98.5 mm Hg by 18.3/9.5 mm Hg with low dose hydrochlorothiazide and by 20.4/9.6 mm Hg with high dose hydrochlorothiazide; more patients achieved goal blood pressure with the high dose. Whites and blacks responded equally. Serum potassium less than 3.5 mmol/1 occurred in 104 of 321 (32.3%) of the high dose versus 62 of 333 (18.6%) of the low dose hydrochlorothiazide patients. The 269 nonresponders to hydrochlorothiazide were randomly assigned in a double-blind study to receive hydralazine, methyldopa, metoprolol, or reserpine in addition to hydrochlorothiazide; 79.2% responded to the addition of the second drug and 87.3% of these completed a 6-month maintenance phase. Overall, there were no significant efficacy differences among the step 2 regimens. We conclude that the lower dose of hydrochlorothiazide was nearly as effective as the higher dose, and the addition of a second drug was effective and generally well tolerated in elderly patients. strate improvement in previously demonstrated behavioral deficits in young men and women after long-term antihypertensive therapy.This study was designed to evaluate the effect of various antihypertensive regimens on blood pressure, biochemical values, symptomatology, and cognitive and behavioral function in an elderly hypertensive population. We performed a double-blind, randomized, multicenter trial that included detailed psychometric testing. The objective of the psychometric testing was to assess the effects of various blood pressure-lowering regimens on memory, motor skills, and other cognitive functions, activities of daily living, and mood for those patients whose blood pressure was controlled. We wanted to determine both the antihypertensive efficacy and comparative adverse effects of 50 mg hydrochlorothiazide (HCTZ) daily compared with 100 mg daily and, in those patients who were nonresponsive to the diuretic, the comparative efficacy and adverse effects

The purpose of the present study was to determine whether the demasculinizing and feminizing effects of prenatal stress (i.e., stress applied to the mother during pregnancy) in rats reported previously are mediated by activation of the maternal pituitary-adrenal axis. Neither whole-body restraint, with or without hyperthermia, nor ACTH treatment during the last third of gestation had any reliable effect on masculine or feminine sexual behavior in male Sprague-Dawley offspring, although these treatments produced maternal pathology and evidence of maternal adrenocorticoid release. Significant littermate similarity was found for almost every morphological and behavioral measure. Failure to control for the litter variable may account for many previously reported effects of prenatal stress on sexual behavior in rats. The discrepancy between the present and earlier findings is discussed in terms of methodological and theoretical considerations.