Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.15.1 (ACE)
 18,300 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Treatment of hypertension in the elderly has so far mainly been based on clinical judgment and very few large controlled trials. During the last year several large new trials have been published, the so-called STOP-Hypertension, SHEP, and MRC trials. All have shown that drug treatment of hypertension in the elderly (65-85 years) with permanent diastolic hypertension or isolated systolic hypertension reduces stroke incidence. Most patients have needed combined drug treatment with diuretics and beta-blockers. When thiazide diuretics are used, serum potassium should be followed very closely and most likely amiloride should be added to the thiazide therapy, since this was done both in the STOP and the MRC trials. Since many elderly patients with hypertension suffer from other diseases that might represent contraindications to thiazide diuretics or beta-blockers, the choice of drug must be made after careful clinical evaluation. With the newer classes of antihypertensive agents (calcium antagonists, ACE inhibitors and alpha-blockers) side effects are probably seen less often, but long-term data on morbidity and mortality are still lacking.
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PMID:Treatment of hypertension in the elderly--what have we learned from the recent trials? 129 75

Specific antihypertensive therapy has been in common clinical use for about four decades. During this relatively short period of time remarkable progress has been made in many regards. The value of lowering elevated arterial pressure has been documented in a number of intervention trials. Initially, such studies comprised patients with malignant hypertension only, but later large-scale studies have comprised patients with non-malignant forms of hypertension. At the same time numerous new pharmacological principles have been taken into clinical use in the treatment of hypertension. It is the purpose of this brief review to sum up some of the important steps that have been taken in this area during previous decades and to try to evaluate the status of current therapies for hypertension. Special emphasis will be given to some of the remaining issues and questions that are currently under investigation, such as the place of novel therapies, e.g. calcium antagonists and ACE-inhibitors, and the issue of the level to which blood pressure should be lowered in order to extract the maximum benefit of antihypertensive treatment. Some of the ongoing large-scale intervention trials in hypertension, e.g. the CAPPP Study, the NORDIL Study, the HOT Study and the STOP Hypertension-2 study, will be reviewed.
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PMID:Status of current therapies for hypertension. 758 83

There is ample evidence that antihypertensive therapy prevents strokes, congestive heart failure, and other blood pressure-related complications, but most trials have failed to show a reduction in coronary events and mortality. Recently, the Systolic Hypertension in the Elderly Program (SHEP) showed a reduction in MIs and other coronary events in older patients with moderate to severe ISH. Cardiovascular mortality was also reduced and there was a trend toward a reduction in coronary events in the Swedish STOP-Hypertension Trial and the British MRC Trial in Older Patients. These studies have in common the use of diuretics and/or beta blockers. Although there are no similar long-term data with calcium channel blockers and ACE inhibitors, they will be the drugs of choice for many patients, based on individual responses and accompanying medical conditions.
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PMID:First-line therapy for hypertension: different patients, different needs. 790 5

The only antihypertensive treatment regimen with documented effect on morbidity and mortality from stroke and coronary heart disease is based on diuretics and/or beta-blockers. However, new antihypertensive drugs are now widely used. These compounds may also prevent cardiovascular complications, but, as yet, this has not been proven. The clinical trials of the 1990s such as STOP II, CAPPP and NORDIL will test whether antihypertensive treatment with ACE-inhibitors and calcium-blockers are more effective than diuretics and beta-blockers in preventing cardiovascular complications. Also, a large-scale study (HOT) is being undertaken to examine how far diastolic blood pressure should be treated, and whether a small dose of aspirin has a protective effect when combined with good control of blood pressure. These studies will hopefully lead to better guidelines for the future treatment of hypertension.
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PMID:[Can treatment of hypertension prevent myocardial infarction? New controlled clinical trials are proposed]. 809 58

It is well established that hypertensive patients benefit from drug treatment of their disorder. In recent years three major out-come studies of antihypertensive treatment in elderly hypertensives have shown substantial benefits, i.e. a reduction in the risk of stroke and other cardiovascular mortality and morbidity. In all these studies beta-blockers and/or diuretics were used in comparison with placebo. Newer therapeutic alternatives have, however, at least theoretically, many advantages which could result in further improvements in prognosis. The initial Swedish Trial in Old Patients with Hypertension (STOP-Hypertension 1) was conducted in men and women aged 70-84 years. STOP-Hypertension 2 will evaluate the therapy used in STOP-Hypertension 1 against therapy based on either ACE-inhibitors (enalapril and lisinopril) or on calcium antagonists (isradipine and felodipine), using the PROBE design (Prospective, Randomised, Open, Blinded Endpoint evaluation). The primary aim will be to assess the effect on cardiovascular mortality. Statistical calculations indicate that 6,600 patients, followed for four years will be needed (2p < 0.05, power 90%) to obtain significance if there is a 25% difference between the new and the established therapy. Patients in primary health care (300 centres) will be included if their supine blood pressure is > or = 180/105 mmHg (and/or). Recruitment of patients started in September 1992 and so far more than 100 patients/week have been included.
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PMID:STOP-Hypertension 2: a prospective intervention trial of "newer" versus "older" treatment alternatives in old patients with hypertension. Swedish Trial in Old Patients with Hypertension. 818 Jul 29

Treatment of elderly hypertensives with beta-receptor blockers and/or diuretics is cost-effective according to the analyses of the results of the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). The cost-effectiveness ratios are low and of the same magnitude for both men and women. The results with respect to reduced risk of cardiovascular disease in STOP Hypertension are also supported by several other studies using the same groups of drugs. The more modern drugs (calcium antagonists, alpha 1 blockers, and ACE inhibitors) have not proven their efficacy in the reduction of cardiovascular events in prospective studies of primary hypertension. It has, however, been shown that they lower blood pressure well also in the elderly and that they are cost-effective among the elderly if treatment with beta-receptor blockers and/or diuretics is contraindicated, provided that they lower the incidence of cardiovascular disease to the same extent as do beta-receptor blockers and diuretics. Studies tackling this latter question are under way, also in the elderly.
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PMID:Cost-benefit aspects of treatment of hypertension in the elderly. 853 36

Treatment of hypertension in the elderly has become not only accepted but also a highly ethical, effective and compelling procedure following the many clearly positive reports on the benefits of lowering elevated arterial pressure in elderly patients. So far most intervention studies in elderly hypertensive patients have used diuretics or beta-blockers or the two in combination as the moiety by which blood pressure has been lowered. However, from a theoretical point of view, more novel therapies could offer advantages that would translate into an even better reduction of cardiovascular morbidity and mortality than has been obtained with the traditional antihypertensive therapies used so far. Some of the studies in elderly hypertensives that are in progress using angiotensin converting enzyme inhibitors or calcium antagonists as the main therapies, e.g. the STOP-Hypertension-2 Study and the Syst-Eur Study, will be briefly reviewed here as will the large data base on urapidil, a dual action antihypertensive drug used in the treatment of elderly hypertensives. By careful evaluation of the effects of novel antihypertensive drugs, and the already existing data base on urapidil in elderly hypertensive patients, it is likely that still better reduction of risk can be obtained in the elderly hypertensives by the use of more novel therapies than diuretics and beta-blockers.
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PMID:Characteristics of an ideal antihypertensive therapy for elderly hypertensives. 853 46

Antihypertensive treatment with diuretics and/or beta-blockers lowers stroke and coronary heart disease morbidity and mortality. However, although the newer antihypertensives induce effective control of blood pressure and regression of hypertensive organ damage, it has not been proven whether they reduce mortality. Ongoing clinical trials such as STOP II, CAPPP, NORDIL, INSIGHT, ALLHAT and LIFE test whether antihypertensive regimens with ACE-inhibitor, calcium-blocker, alpha-blocker and Angiotensin II-antagonist are equally good or possibly even better than diuretics and beta-blockers in preventing cardiovascular complications. The HOT trial clarifies how much the diastolic blood pressure should be lowered, and whether a small dose of aspirin has a protective effect when combined with optimal control of blood pressure. These studies should give better guidelines for the treatment of hypertension.
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PMID:[Status of ongoing controlled clinical trials on hypertension]. 1535 9

Hypertension occurs in 50% of the elderly persons in industrialized societies. This disorder of the regulation of the arterial blood pressure has different manifestations in different age groups. The young hypertensive usually has an increase in cardiac output and a normal peripheral vascular resistance. The elderly patient with hypertension exhibits a decreased cardiac output and an increased peripheral vascular resistance. In the elderly hypertensive there is a progressive anteriolar narrowing and there is hardening of the largest arteries. The vascular disease that contributes to the hypertension in the elderly also causes hypoperfusion of the target organs. During the aging process there is a decrease in cardiac output, glomerular filtration rate, vital capacity, renal plasma flow and maximal cardiac rate. There are changes in the kidneys and the liver that influence the way different medications are handled by the body. The main findings of the Australian, EWPHE, Coope & Warrender, SHEP, STOP-HYP and MRC studies of hypertension in the elderly have been summarized. The intervention studies have proven that the treatment of hypertension in the elderly patient is efficacious and decreases the mortality and morbidity due to coronary and cerebrovascular events. The pharmacologic agents available for the treatment of hypertension in the elderly are the diuretics, beta blockers, vasodilators, calcium-channel blockers, adrenergic blockers and angiotensin converting enzyme inhibitors. The morbidity and mortality benefits derived from antihypertensive trials are greater for the older than for the younger patients. The pharmacologic antihypertensive agents to be used in older patients will also depend upon the presence or not of associated illnesses in which some agents might be harmful or contraindicated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hypertension in old age]. 858 23

Drug treatment with beta-blockers and diuretics in hypertensive men and women aged 70 and above confers highly significant and clinically relevant reductions in cardiovascular (especially stroke) morbidity and mortality. This satisfactory effect is not impaired by a low tolerability of the drugs used. Furthermore, treatment of elderly hypertensives with beta-receptor blockers and/or diuretics is cost-effective. In STOP-Hypertension the cost-effectiveness ratios were low and of the same magnitude for both men and women. The clinical implication of this is that blood pressure lowering therapy should be considered in elderly hypertensives, at least up until they are 80 years old. It should also be remembered that elderly patients often have other diseases than hypertension and that the drug treatment should be adjusted accordingly, e.g. by using a calcium antagonist or an ACE inhibitor, when indicated.
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PMID:Antihypertensive treatment in the elderly. 874 33


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