Essential Hypertension in the Elderly

Messerli, Franz H.; Ventura, Héctor O.; Glade, Louis B.; Sundgaard-Riise, Kirsten; Dunn, Francis G.; Fröhlich, Edward D.; Vitez, Terry S.

doi:10.1097/00132586-198406000-00068

Cited by 5 publications

(6 citation statements)

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“…Calcium-channel blockers may be most effective in patients with decreased plasma renin activity, which is a common finding in the elderly. These agents also exert antianginal effects [44]. However, the sodium retention and constipation sometimes seen with these drugs can be especially troublesome for the elderly [45].…”

Section: Therapeutic Considerationsmentioning

confidence: 99%

“…However, the sodium retention and constipation sometimes seen with these drugs can be especially troublesome for the elderly [45]. ACE inhibitors lower peripheral vascular resistance, but they are most effective in high plasma renin activity states [44]. In the (presumably rare) event of bilateral renal artery stenosis, their usage could precipitate renal failure.…”

Section: Therapeutic Considerationsmentioning

confidence: 99%

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Systolic hypertension in the elderly

Rutan

1991

Cardiovasc Drug Ther

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Historically diastolic blood pressure (BP) rather than systolic BP has been regarded clinically as the more important component related to subsequent hypertensive morbidity and mortality, and treatment has thus been directed towards lowering the diastolic BP. Observational studies across many different populations have related cerebrovascular disease and death more to the systolic BP, which appears selectively to increase as the population ages. Isolated systolic hypertension (ISH), therefore, may be more prevalent as westernized societies become older. Those affected with ISH suffer a two- to fivefold increase in rates of stroke and ischemic heart disease compared to normotensives. Currently no clinical trials data exist for ISH showing the efficacy of antihypertensive therapy upon final morbidity and mortality, but a large-scale multicenter clinical trial, the Systolic Hypertension in the Elderly Program (SHEP), is currently underway in the United States. Results are expected in the early 1990s. If the results of this trial confirm the efficacy of treating ISH, the therapeutic challenge of ISH will be to selectively decrease systolic BP without undue side effects.

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Section: Therapeutic Considerationsmentioning

confidence: 99%

Section: Therapeutic Considerationsmentioning

confidence: 99%

Systolic hypertension in the elderly

Rutan

1991

Cardiovasc Drug Ther

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“…Thus, with increasing age, these counteracting forces may keep the diastolic pressure normal while, in the background, there is increasing systolic pressure. [4][5][6] Primary health care in Nigeria is heavily financed in many states and constitutes the first and perhaps the only port of call for orthodox care for many patients who suffer from chronic, often asymptomatic diseases METHODS: ISH was defined according to international guidelines. Treatments were graded as relatively non-aggressive, mildly aggressive and moderately aggressive.…”

Section: Introductionmentioning

confidence: 99%

Isolated systolic hypertension: primary care practice patterns in a Nigerian high-risk subpopulation

2006

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CONTEXT AND OBJECTIVE: Hypertension management and risk prediction based on diastolic blood pressure may be of little value for older people and people with isolated systolic hyper-tension (ISH). This study investigated primary care practice patterns in ISH management in a Nigerian high-risk subpopulation. DESIGN AND SETTING: Three-year retrospective cohort review of outpatient medical records at a state primary health care facility in southwestern Nigeria. METHODS: ISH was defined according to international guidelines. Treatments were graded as relatively non-aggressive, mildly aggressive and moderately aggressive. Data were collected using a data abstraction form and statistically analyzed. RESULTS: The drug/regimen choice controlled systolic blood pressure (SBP) in only 46.90% of the population after the first visit to the clinic. SBP control among treated patients was significantly inadequate. Group mean SBP was consistently > 150 mmHg in 28.13% of the patients for ³ six weeks after enrollment and for at least two additional visits. Data analysis revealed an increasing tendency to place patients on monotherapy or "no drug treatment" with successive visits to the clinic, even in cases of uncontrolled systolic blood pressure, as well as declining prescription of moderately aggressive combination therapy. CONCLUSION: Aggressive ISH management needs to be further emphasized at primary care levels, which for many low-income patients may be the first and last orthodox port of call.

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“…The elderly hypertensive patient is characterised by a decrease in cardiac output, renal blood flow, and intravascular volume and an increase in total peripheral resistance and vascular resistance. Left ventricular hypertrophy and signs of disturbed left ventricular diastolic function are often prevalent in elderly hypertensive patients (Messerli 1985(Messerli ,1990Wikstrand 1986Wikstrand ,1988. Structural changes appearing with age in the cardiovascular system (Lemfelt et al 1991) may be of the same nature and might interact with changes related to hypertension.…”

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confidence: 99%