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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Systolic blood pressure (SBP) increases by aging. In contrast, diastolic blood pressure (DBP) decreases after age 60 because of lowering aortic compliance. Therefore, isolated systolic hypertension (ISH) is common in the elderly. ISH is a risk for cardiovascular complications, and induces a left ventricular hypertrophy combined with diastolic dysfunction. Diastolic heart failure followed by diastolic dysfunction is more common than systolic heart failure in the elderly. Furthermore, changes in neuroendocrine systems by aging may lead orthostatic hypotension, non-dipping status, large blood pressure variability, and reduced heart rate variability. In the management of elderly hypertension, the understanding for these age-related hemodynamic changes is very important.
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PMID:[Age related hemodynamic changes in the elderly]. 1594 77

Many randomized trials have shown that a reduction in salt intake lowers blood pressure in hypertensive individuals. However, few have looked at the effects according to hypertension category. A recent analysis of the third and fourth National Health and Nutrition Examination Survey suggests that salt intake may not be related to blood pressure in isolated systolic or combined hypertension. To look at this further, we reanalyzed the data of our previous salt reduction trials. Hypertensive individuals were studied in randomized double-blind crossover studies: 1 month of usual salt intake compared with 1 month of reduced salt intake. In isolated systolic hypertension (n=24), blood pressure was reduced from 166+/-19/86+/-7 to 156+/-20/85+/-7 mm Hg (systolic P<0.001; diastolic P=0.459) with a reduction in urinary sodium from 175+/-51 to 87+/-38 mmol per 24-hour period (10.3 to 5.1 g per day of salt). In combined hypertension (n=88), blood pressure was reduced from 161+/-16/100+/-9 to 154+/-17/96+/-9 mm Hg (P<0.001) with a reduction urinary sodium from 176+/-65 to 98+/-51 mmol per 24-hour period (10.4 to 5.8 g per day of salt). These results demonstrate that salt reduction has a significant effect on blood pressure in isolated systolic and combined hypertension. The fall in systolic observed in isolated systolic hypertension would be predicted to reduce stroke by approximately one third, ischemic heart disease by one quarter, and heart failure by one quarter in the population between 60 and 80 years of age, in whom isolated systolic hypertension is the predominate form of hypertension and carries the highest risk. These results provide strong support for universal salt reduction in all hypertensives.
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PMID:Modest salt reduction lowers blood pressure in isolated systolic hypertension and combined hypertension. 1595 12

The increasing knowledge on bone calcification processes has revealed some similarities with vascular tissue, where calcifications of arteries and cardiac valves contribute to several cardiovascular problems, such as heart failure, systolic hypertension, and myocardial and peripheral ischemic disease. Bisphosphonates have been used extensively for over two decades for the treatment of diseases associated with excessive bone resorption, i.e., osteoporosis, osteolytic bone metastasis, hypercalcemia and Paget's disease, by blocking osteoclastic function. Etidronate, pamidronate and clodronate has been shown to inhibit the development of experimental atherosclerosis, and proposed mechanisms for this action include inhibition of arterial calcification and lipid accumulation, degradation of atherogenic LDL-cholesterol and reduced foam cell formation. Bisphosphonates inhibit various enzymes involved in cholesterol biosynthesis and suppress macrophages in atheromatous lesions. The possibility of pharmacological agents that effectively treat both osteoporosis and atherosclerosis is attractive, however, current evidence is not conclusive and further research is necessary to confirm these actions in the clinical setting.
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PMID:Bisphosphonates and atherosclerosis: why? 1721 1

Beta-blockers have been considered for decades as effective agents in preventing coronary events in hypertensive patients. Actually, the scrutiny of the available data arises some doubts over the real value of this pharmacological class. In primary prevention, the clinical benefits of beta-blockers are poorly documented: the studies conducted against placebo (MRC, IPPPSH...) did not show any significant differences regarding the rate of coronary events (except within non smokers); moreover, the beneficial effect of propranolol in preventing sudden deaths and silent myocardial infarctions has been reported byjust one retrospective analysis. Likewise in HAPPHY study, the comparison with diuretics did not emphasize a clear superiority of one of both classes; the better effect of metoprolol regarding overall mortality and fatal coronary events was shown in the pecular subset MAPHY, only. Furthermore, in elderly people, HEP, MRC OA and STOP studies did not find any significant effect of beta-blockers in preventing coronary events, as compared with placebo. However, SHEP study, which involved patients older than 60 years with isolated systolic hypertension receiving first a diuretic, then a beta-blocker(atenolol) in 1/4 of the cases, demonstrated a significant reduction versus placebo both in strokes and in coronary events. Finally, in UKPDS, CAPP, LIFE and CONVINCE studies, atenolol turned out to have a similar efficacy as captopril, losartan and verapamil, in preventing ischemic heart disease. Among the numerous published meta-analyses, that of Psaty pointed out the absence of a primary cardioprotective effect by beta-blockers; more recently, that of Carlberg, emphasized atenolol given alone as the first-line drug to fail in significantly reducing coronary events and strokes. In secondary prevention, some more convincing data may be found in the literature, regarding post myocardial infarction patients (meta-analyses of Staessen, 1982, Yusuf, 1985 and Soriano, 1997), as well as those with stable angina (BIP study in diabetics) or silent ischemia (ASIST study: significant reduction in number and duration of ischemic events by atenolol). Moreover, INVEST study recently showed atenolol and verapamil to have an equivalent efficacy in the hypertensive patients with stable coronary artery disease. Last, hypertension should be reminded as resulting in many cases of heart failure, a pathology where beta-blockers have clearly demonstrated their beneficial effects.
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PMID:[Do beta-blockers prevent coronary events in hypertensive patients?]. 1623 74

In most European countries and Northern America, cardiovascular diseases induced by atherosclerosis are the most common cause of death in older people. People surviving acute myocardial infarction or stroke suffer often by disabilities or handicaps. The lifelong care of such patients is expensive and plays a major role for increment of costs in public health systems. Prevention of atherosclerosis will reduce cardiovascular morbidity and mortality, enhance quality of life and prolong lifetime of patients. Therefore the worldwide accepted risk factors of atherosclerosis have to be treated consequently and early enough within the meaning of primary prevention. Hypertension is one of the six major cardiovascular risk factors and is defined as elevated blood pressure above 140/90 mmHg. In case of hypertension, diagnostic efforts has to be focussed on detection of additional cardiovascular risk factors, secondary forms of hypertension, end organ damage or associated diseases. All therapeutic strategies are based on life style changes, which cover weight reduction, sodium restriction, controlled alcohol consumption and increment in physical activity. Pharmacotherapy will be added in regard to the global risk of the patient and the success of the life style changes. Selection of antihypertensives and their optimal combination will be determined by associated diseases (compelling indication), side effects and individual response in blood pressure. Goal of treatment is the normalization of blood pressure below 140/90 mmHg independent of age or sex. In diabetics and in case of nephropathy the goal is set lower (below 130/80 mmHg).There is strong evidence that reduction in blood pressure is followed by a decrease in the incidence of myocardial infarction, stroke, heart failure, nephropathy, and even in cardiovascular mortality. The success of antihypertensive therapy is greater in high risk patients like older people, patients with isolated systolic hypertension or diabetics. Risk reduction correlates well with the degree in blood pressure reduction. However, to minimize cardiovascular risk in hypertensives all additional risk factors have to be treated too.
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PMID:[Prevention of arteriosclerosis. Importance of the treatment of arterial hypertension]. 1625 93

Isolated systolic hypertension (ISH) is an important cause of strokes and heart failure among the elderly, but it is difficult to control in some elderly patients, even with combination antihypertensive therapy. The presence of a prominent reflection wave in the arterial pulse-wave profile of such patients signifies that adjuvant nitrate therapy may prove effective in lowering pulse pressure. This reflection arises in the muscular arteries and is caused by arterial stiffness associated with hypertension and other cardiovascular risk factors, probably including endothelial dysfunction. By acting directly on the arterial wall, nitrates produce endothelium-independent vasorelaxation. The reflection wave and the contribution this makes to pulse pressure are thereby ablated. Controlled trials of the use of isosorbide mononitrate and isosorbide dinitrate in ISH have shown that these agents decrease systolic blood pressure as well as pulse pressure, and with the mononitrate, efficacy appears to be unimpaired by nitrate tolerance.
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PMID:Nitrates as adjunct hypertensive treatment. 1660 Jan 61

Hypertension is defined by the Joint National Committee (JNC 7) as blood pressure (BP) > or =Y130/80 mmHg. It affects up to 70% of patients with type 2 diabetes and is twice as prevalent in diabetics as in non-diabetics. Due to its contribution to renal and cardiovascular disease, hypertension increases diabetic mortality four to five-fold. Therefore, a BP goal of 130/80 mmHg or less (125/75 mmHg in patients with proteinuria >1 g/die and increased creatinemia), is recommended. For isolated systolic hypertension, defined as a systolic BP > or =Y180 mmHg with normal diastolic BP, the treatment goal is to reduce systolic BP to <160 mmHg. The evidence from most trials suggests that there are only minimal differences between the various antihypertensive drugs, and that almost all agents are capable of successfully reducing adverse clinical events. Nevertheless, there is evidence that certain drugs are more useful in preventing damage to a specific organ system; and therefore, the selection of the therapy should be guided by the presence of concomitant disease and the protection of the organ system that is most at risk. Beta-blockers and calcium channel blockers are effective antianginals; diuretics, angiotensin-converting enzyme (ACE) inhibitors and beta-blockers are useful for heart failure; ACE inhibitors and angiotensin receptor blockers are especially effective in preserving renal function. Adequate BP control, irrespective of the type of antihypertensive drugs used, should replace the academic debate on what is the best antihypertensive agent.
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PMID:[Antihypertensive drugs in diabetic's hypertension]. 1663 91

Once considered part of the normal aging process, the development of isolated systolic hypertension represents a late manifestation of increased arterial stiffness in older people. Furthermore, isolated systolic hypertension is the single most frequent subtype of hypertension in the US adult population. Indeed, central arterial stiffness rather than peripheral vascular resistance becomes the dominant hemodynamic factor in both normotensive and hypertensive individuals after the age of 50-60 years. Stiffening disease, an age-related degeneration of the elastic elements of the thoracic aorta, is associated with a widening of brachial pulse pressure. Brachial pulse pressure predicts future cardiovascular disease events. However, pressure wave amplification produces higher brachial than aortic pressures and, therefore, central rather than peripheral blood pressure indices are more reliable measures of cardiovascular risk. Stiffening disease of aging is accompanied by early wave reflection, which results in a significant augmentation of central systolic pressure in late systole and further adds to increased cardiac afterload--so-called ventricular-vascular uncoupling. Diabetes, impaired renal function, and untreated or poorly treated hypertension may lead to premature arterial stiffening; its consequences are stiffening and hypertrophy of the left ventricle and predisposition to coronary heart disease, heart failure, stroke, vascular dementia, and chronic kidney disease.
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PMID:Hypertension in older people: part 1. 1676 Jun 85

Pulse pressure provides information beyond systolic and diastolic blood pressures, from which it is calculated. The majority of individuals older than 70 years have a widened pulse pressure resulting from age-related stiffening of the central elastic arteries and systolic hypertension. A widened pulse pressure is associated with cardiovascular risk factors such as diabetes, hypertension, and smoking. It also predicts a higher risk of subsequent cardiovascular events, stroke, renal disease, heart failure, and mortality, particularly in the elderly. The authors review the mechanisms that contribute to pulse pressure and the association between pulse pressure, vascular risk factors, and outcomes.
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PMID:Pulse pressure and vascular risk in the elderly: associations and clinical implications. 1684 88

There is overwhelming evidence that pharmacologic treatment of isolated systolic hypertension (ISH) (systolic blood pressure >or=140 mm Hg and diastolic blood pressure <90 mm Hg) reduces cardiovascular events and extends longevity in the elderly; in the very old (80 years or older), the evidence supports decreased incident stroke and heart failure, but is less convincing in terms of longevity. Thus, the inherent increased risk for ISH vascular events highlights the importance of its control. Importantly, ISH in the elderly, primarily related to large artery stiffness, remains more difficult to control than diastolic hypertension in the young, which is primarily related to increased peripheral vascular resistance. Appropriate lifestyle and pharmacologic intervention is indicated in individuals with systolic blood pressure >or=140 mm Hg in general and >or=130 mm Hg in persons with diabetes or chronic kidney disease. Lifestyle intervention may reduce the need for extensive antihypertensive therapy and minimize associated cardiovascular risk factors. To date, only a small percentage of older ISH patients are being treated to goal. Reaching target systolic blood pressure levels most often requires the use of polypharmacy that includes a diuretic and perhaps specific agents that target arterial stiffness and early wave reflection.
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PMID:Hypertension in older people: part 2. 1684 7


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