Hypertension in the Elderly: Haemodynamic, Fluid Volume and Endocrine Findings

Messerli, Franz H.; Glade, Louis B.; Dreslinski, Gerald R.; Dunn, Francis G.; Reisin, Efrain; MacPhee, Allan A.; Fröhlich, Edward D.

doi:10.1042/cs061393s

Cited by 26 publications

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“…*" 16 In elderly patients in whom cardiac output is lower and myocardial reserve impaired," cardiac function may depend more on endogenous adrenergic support than in younger subjects. It is not surprising, therefore, to see some fall in cardiac output in the older patients, since methyldopa, by its central action and also by lowering circulating norepinephrine levels, may interfere with such adrenergic cardiovascular support.…”

Section: Figure 2 Hemodynamic Responses To Isometric Exercise (Handgrmentioning

confidence: 99%

Antiadrenergic therapy: special aspects in hypertension in the elderly.

Messerli¹,

Dreslinski²,

Husserl³

et al. 1981

Hypertension

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SUMMARYThe effect of antiadrenergic treatment with methyldopa was studied in 17 patients with established essential hypertension who were subdivided with respect to age in a group younger (n = 10; mean age, 47 ± 2.4 (SEM) years; and a group older than 60 years of age (n = 7, mean age, 67 ± 2.8 SEM). The fall in arterial pressure was associated with a significant (p < 0.05) decrease in cardiac output and heart rate in patients over 60 years of age and no change in total peripheral resistance, whereas a (nonsignificant) fall in resistance occurred in younger patients. In both age groups, a significant (p < 0.05 and < 0.01, respectively) decrease in plasma norepinephrine levels was observed, whereas epinephrine and dopamine showed no changes. renergic drug, has been available for more than a quarter of a century as a reliable antihypertensive agent.1 Although its mechanism of action has been elucidated only recently, 1 " 7 controversy still exists regarding its hemodynamic effects. Early studies had indicated that the antihypertensive effect occurs by a reduction in cardiac output, 810 whereas other reports suggested that this was mediated by a decrease in total peripheral resistance. "15 Since hypertension in the elderly is associated with distinct hemodynamic, fluid volume, and endocrine alterations, 1 " we hypothesized that the age of the patient may significantly influence the mechanisms of the antihypertensive response. Accordingly, the present study was designed to evaluate hemodynamic, circulating humoral, and intravascular volume changes in 17 patients who were subdivided into groups older and younger than 60 years of age. MethodsSeventeen patients with established essential hypertension were included in the present study. They were subdivided with respect to age in a group younger (n = 10, mean age 47 ± 2.4 (SEM) years) and older than 60 years of age (n = 7, mean age 67 ± 2.8 SEM). Race, sex, body height, weight, and surface area (2.05 ± 0.06 and 1.97 ± 0.1 M 2 ) were similar in the two groups. Antihypertensive treatment was discontinued at least 4 weeks before the study was initiated. The research protocol had been approved previously by our clinical investigation committee and informed consent was obtained from all patients. Two hemodynamic evaluations were performed, the first after the patient had remained off treatment for 4 weeks and the second after the patient had taken methyldopa for 4 to 6 weeks. During the treatment period the dose of methyldopa was titrated in the outpatient department gradually from 250 mg twice a day to a maximum of 2.0 g per day according to the response of arterial pressure. The average dose was 0.9 and 0.6 g per day in the younger and older group respectively. Routine laboratory blood and urine tests as well as pulmonary function studies (pulmodigitalizer) were done 1 day before or after the hemodynamic measurements were made. 11-226by guest on May 10, 2018 http://hyper.ahajournals.org/ Downloaded from

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Section: Figure 2 Hemodynamic Responses To Isometric Exercise (Handgrmentioning

confidence: 99%

Antiadrenergic therapy: special aspects in hypertension in the elderly.

Messerli¹,

Dreslinski²,

Husserl³

et al. 1981

Hypertension

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Controversies in hypertension: Mild hypertension, isolated systolic hypertension, and the choice of a step one drug

Cressman

Gifford

1983

Clinical Cardiology

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The realization that cardiovascular morbidity and mortality increases in patients with mild elevation of either systolic or diastolic blood pressure has led to a consideration to treat millions of patients with mild diastolic or isolated systolic hypertension. The cost of administering a successful antihypertensive treatment program and the potential adverse effects of pharmacologic agents is of great concern. It has been emphasized that the risk of premature mortality differs in individual patients according to the number of associated cardiovascular risk factors at any level of blood pressure. This has led to a suggestion that only high risk patients be treated. However, a significant number of low risk patients with mild hypertension develop a more severe or complicated form of their disease even over a follow-up period of five to ten years. There is no good way to identify these patients. Trials of antihypertensive therapy suggest a beneficial effect of blood pressure lowering in mild hypertension. No trials of antihypertensive therapy in elderly patients with isolated systolic hypertension have been reported, but the elevation in systolic blood pressure appears to be an independent risk factor for cardiovascular mortality. Even the choice of the first step agent in treatment is debatable. Diuretics or beta blockers effectively lower blood pressure in the majority of hypertensive patients, particularly if modest dietary sodium restriction is achieved. The incidence of side effects, either symptomatic or biochemical, is similar but diuretics are unquestionably cheaper and probably more effective. Successful application of an antihypertensive treatment program may continue to reduce our unacceptably great incidence of cardiovascular disease.

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Hypertension in the Elderly: Conventional Wisdom Revisited

Lopez

1991

Pharmacotherapy

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Elevated systolic and/or diastolic blood pressure in the elderly is a problem the extent of which may be somewhat overstated. In those elderly with definite hypertension, pathophysiology may differ from that of younger counterparts. The contribution of elevated plasma renin activity to hypertension and to the choice of therapy also appears to be exaggerated. The risks of ignoring hypertension in the elderly are similar to those in younger patients, and therefore excessively elevated blood pressure should no longer be considered a normal consequence of aging. Notably, elevated systolic pressure is a better predictor of future adverse occurrences than is elevated diastolic pressure. Unfortunately, there is no well defined therapeutic regimen to manage isolated systolic hypertension. Conservative reduction of elevated systolic and diastolic pressures may nevertheless be accomplished safely and effectively. Individualization of therapy is recommended based primarily on concomitant disease(s). Thus no single agent or combination of agents is preferable in all elderly hypertensive patients. Aggressive use of non‐pharmacologic therapy preferably precedes judicious of antihypertensive medication. Aggressive blood pressure reduction with potent drugs is not recommended.

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Hypertension in the Elderly: Haemodynamic, Fluid Volume and Endocrine Findings

Cited by 26 publications

References 0 publications

Antiadrenergic therapy: special aspects in hypertension in the elderly.

Antiadrenergic therapy: special aspects in hypertension in the elderly.

Controversies in hypertension: Mild hypertension, isolated systolic hypertension, and the choice of a step one drug

Hypertension in the Elderly: Conventional Wisdom Revisited

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