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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hypertension is a major contributor to cardiovascular morbidity and mortality, increasing risk threefold. It predisposes to every clinical manifestation of coronary heart disease, now the most common and lethal outcome. It is as relevant a risk factor in the elderly as in the young. Risk is proportional to the degree of blood pressure elevation without a discernible critical value. Cardiovascular sequelae do not derive chiefly from the diastolic component, and isolated systolic hypertension confers increased risk at all ages. Hypertension tends to cluster with other cardiovascular risk factors, which must be taken into account in evaluating the risk and in choosing treatment. The excess cardiovascular risk in hypertension is concentrated in those with an increased total/high density lipoprotein cholesterol ratio, glucose intolerance, cigarette smoking, elevated fibrinogen, and electrocardiogram abnormalities. Left ventricular hypertrophy (LVH) is a common feature of hypertension and an ominous harbinger of cardiovascular sequellae. Electrocardiographic evidence of LVH, when manifested by repolarization abnormalities and voltage elevations, is particularly hazardous, reflecting not only anatomical hypertrophy but also ischemia. Electrocardiogram-LVH adds to cardiovascular risk associated with X ray or echocardiographic evidence of anatomical LVH. Because of a tendency to ventricular ectopy, LVH is associated with increased risk of sudden death. Electrocardiogram-LVH can be corrected or avoided by control of hypertension and weight reduction. The efficacy of correcting LVH remains to be demonstrated but benefits seem likely.
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PMID:Hypertension, hypertrophy, and the occurrence of cardiovascular disease. 183 77

The influence of age and severity of hypertension on the blood pressure response to isometric handgrip exercise (IHG) was studied in essential hypertensive patients (n = 122). The change in blood pressure during IHG in elderly patients with isolated systolic hypertension (ISH) (n = 12) was also studied. Left ventricular hypertrophy due to hypertension was used as an index of the severity of hypertension. The change in systolic blood pressure (SBP) during IHG was markedly greater in essential hypertensives than in normotensive subjects (n = 36). Among hypertensive patients, the change in SBP increased with increasing severity of hypertension. This change in SBP was not influenced by age. The change in SBP during IHG in patients with ISH was significantly smaller than that in essential hypertensive patients and was similar to that in normotensive subjects in the elderly. These results demonstrate that age does not affect the increased blood pressure response to IHG in essential hypertensive patients but the greater the severity of hypertension, the greater the increase in SBP during IHG. Elderly patients with ISH do not have an enhanced blood pressure response to IHG.
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PMID:Influence of age and severity of hypertension on blood pressure response to isometric handgrip exercise. 183 64

Hypertension is a major risk factor for cardiovascular disease, particularly coronary heart disease. Risk increases with the severity of hypertension, irrespective of age or sex. However, the absolute risk is greatest in the elderly, for whom isolated systolic hypertension is particularly important. Hypertension is often accompanied by other risk factors. For example, the levels of cholesterol and high- and low-density lipoproteins are important. Diabetes increases the risk of cardiovascular disease at any level of blood pressure. Smoking increases the risk from hypertension and stopping smoking can dramatically reduce risk. A raised heart rate increases the risk of coronary events in both hypertensive and normotensive patients. However, heart rates tend to be higher in hypertensive patients. Left ventricular hypertrophy combined with hypertension increases the risk of coronary heart disease. An elevated level of fibrinogen increases the risk of cardiovascular disease in both hypertensive and normotensive patients, though the risk is greater at higher blood pressures. Cardiovascular risk profiles have been constructed to identify patients at high risk.
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PMID:Office assessment of coronary candidates and risk factor insights from the Framingham study. 183 69

Vascular dementia (VD) is the second most common cause of dementia in the elderly after Alzheimer's disease (AD). Prevalence estimates from community surveys indicate that, on average, 5% of persons over 65 and 15 to 20% of people over 80 suffer from "severe dementia". Clinico-pathological studies have shown that AD accounts for 50 to 60% of the cases and VD for about 10 to 20%; 20% of the patients have both disorders. The incidence rate of VD ranges from 7 per 1,000 person-years in normal volunteers to 16 per 1,000 person-years in subjects with risk factors for strokes, particularly high blood pressure. The only effective therapeutic approach to VD is the prevention of strokes, mainly through the treatment of hypertension; however, none of the therapeutic trials has included VD prevention as one of its treatment goals. Syst-Eur Study is a European placebo controlled trial which aims to determine whether morbidity and mortality are changed when elderly patients (60 years and over) with isolated systolic hypertension are treated. In this trial, the incidence of VD will be carefully recorded during the five year follow-up of the expected 3,000 patients. The present side project to the Syst-Eur trial will specifically address the following questions: does antihypertensive treatment reduce the incidence of VD?, and how do the cognitive functions of elderly patients change when treated with active or placebo treatment? The protocol is based on the administration of the MMS (Folstein) once a year to all patients. If the MMS score is 23 or less, a set of criteria will be used to establish the diagnosis of vascular dementia. A pilot study has demonstrated the feasibility of the trial. The main study is in progress.
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PMID:Is prevention of vascular dementia possible? The Syst-Eur Vascular Dementia Project. 184 9

The aim of the study was to analyse the course of isolated systolic hypertension in old age and its influence upon quoad vitam prognosis. A group of 100 persons over 60 was chosen and observed systematically for the period of 10 years in the geriatric out-patients centre. On the basis of pattern of arterial pressure in the 10-year-period the patients were qualified into several types of hypertension. Isolated systolic hypertension occurred mostly in the late old age over 70 and was characterized by irregular occurrence of periods of hypertension alternately with periods of normotension without any tendency to increase hypertension with the advance of old age. Cases of death caused directly by hypertension were found more frequently in the group with systolic-diastolic hypertension (56%) than in the group with isolated systolic hypertension (36%).
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PMID:The dynamics of isolated systolic hypertension during the 10-year period of geriatric treatment. 184 77

We examined the relationship of hypertension to left ventricular hypertrophy (LVH) and left ventricular diastolic function by ambulatory blood pressure monitoring device and echocardiography. We studied 36 untreated hypertensive non-diabetic patients (16 males and 20 females) whose casual systolic blood pressure (CSBP) and/or diastolic blood pressure (CDBP) were higher than 140 mmHg and 90 mmHg, respectively. All patients were less than 65 years of age without organic heart disease. Resting systolic and diastolic blood pressures (RSBP, RDBP) were measured after lying in a supine position for 30 min by the auscultatory method. Ambulatory blood pressure was measured every 30 or 60 min for 24 hours by Colin ABPM 630, and the mean 24-hour ambulatory systolic and diastolic blood pressures (ASBP, ADBP) and the systolic and diastolic hyperbaric indices (SHI, DHI) were obtained. The left ventricular mass index (LVMI) was obtained as an indicator of LVH by M-mode echocardiography. The ratio of peak velocity of mitral inflow caused by atrial contraction to that of rapid inflow (A/R) was obtained as an indicator of the LV diastolic function by Doppler echocardiography. The coefficients of correlation between BP and the LVMI, and the A/R were determined. There were significant positive correlations between the LVMI and ASBP (r = 0.51, p < 0.005), the SHI (r = 0.49, p < 0.005), CSBP (r = 0.47, p < 0.01) and RSBP (r = 0.41, p < 0.05), however, there were no significant correlations between the LVMI and ADBP, the DHI, CDBP, RDBP and age. There were significant positive correlations between the A/R and ADBP (r = 0.44, p < 0.01), age (r = 0.40, p < 0.02), CSBP (r = 0.38, p < 0.05) and RDBP (r = 0.38, p < 0.05), however, no significant correlations between the A/R and ASBP, the SHI, DHI, RSBP and CDBP. Only a weak correlation was observed in all subjects between the LVMI and A/R, which was slightly improved by use of > 90 mmHg CSBP readings (r = 0.32). It was concluded that LVH is related mainly to continuous systolic hypertension, and that LV diastolic dysfunction is related mainly to continuous diastolic hypertension. Therefore, it was suggested that LVH and LV diastolic dysfunction in hypertensive patients are caused by different mechanisms.
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PMID:[Correlations between blood pressure, left ventricular hypertrophy, and left ventricular diastolic function in hypertensive patients]. 184 49

Paradoxically greater survival for persons aged 85 years and older with higher blood pressures has been reported in a Finnish population study (Br Med J 1988;296:887-9). In a previous report, the authors demonstrated improved 10-year survival with increasing diastolic blood pressure in men (but not in women) aged 75 years and older in the Rancho Bernardo Chronic Disease Study (Br Med J 1989;298:1356-7). However, few of the covariates which could potentially explain this effect were obtained at the visit used in that analysis. In an effort to confirm these reports of paradoxical survival and to explore possible reasons for them, the authors analyzed all-cause and cardiovascular mortality in 795 men and women aged 75-96 years (mean, 80.6), evaluated in 1984-1987 and followed prospectively for an average of 3 years after that comprehensive examination. Of 63 deaths, 48 (76%) were in men; 43 (68%) of all deaths were cardiovascular. Kaplan-Meier survival analyses showed a significant trend for improved survival with increasing diastolic pressure in men aged 80 years and older versus all-cause mortality (chi 2 p less than or equal to 0.01), and cardiovascular mortality (chi 2 p less than or equal to 0.00). These trends were not evident in men aged less than 80 years or in women in either age group. Results were not explained by differences in the use of antihypertensive medication, pulse pressure, history of hypertension, history of coronary heart disease, isolated systolic hypertension, interval change in diastolic pressure (over an average of 12 years), or by cholesterol, triglycerides, fasting plasma glucose, smoking, or body mass index. Thus, the paradoxical relation of improved all-cause and cardiovascular survival in men aged 80 years or older with higher diastolic pressure is not explained by a wide range of biologic and historical factors.
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PMID:Factors associated with paradoxical survival at higher blood pressures in the very old. 185 58

This article shows the epidemiologic dimension of hypertension in the elderly. The number of the elderly in Switzerland is expected to increase significantly until the first decades of the new millenium; therefore, geriatric medicine and hypertension in the elderly in particular will become even more important than it is at present. Cardiovascular disease is blamed for a major share of prematurely lost years of life. In the past few years the age-standardized mortality of ischaemic heart disease has declined in Switzerland, while the rate for cerebrovascular disease has gone down earlier. The project MONICA may explain the reasons for these trends. Hypertension shows also in Switzerland a high prevalence, which even increases in older age groups. In the Framingham cohort study (USA) it was shown that hypertension is the most important risk factor for cardiovascular morbidity and mortalitity in the elderly. This is particularly true for the most common form of hypertension in the elderly, the isolated systolic hypertension. Because of the described demographic development, hypertension in the elderly, its prevention, diagnosis and management will become even more significant.
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PMID:[Epidemiology of hypertension in old age]. 185 98

According to several recent studies prevalence of hypertension in the elderly ranges from 40 to 60%. Both, systolic as well as diastolic increase of blood pressure must be regarded as individual cardiovascular risk factors. Treatment of hypertension in the elderly gains special importance in the presence of additional risk factors. There is no doubt about the benefit of antihypertensive therapy when the diastolic value amounts to 100 mmHg and more. No reliable data exist so far on a beneficial effect of the treatment of systolic hypertension. Whether hypertensive patients older than 80 years and patients with only marginal increases of blood pressure benefit from antihypertensive treatment has not been proven by current studies. If the patient's anamnesis includes cerebral stroke a cautious antihypertensive therapy may reduce cardial insufficiency without increasing the risk for another apoplexia.
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PMID:[Hypertension in the aged: when to treat it?]. 185

Considerable evidence suggests that hyperactivity of the sympathetic nervous system is implicated not only in the pathogenesis of essential hypertension but also in several blood pressure-independent complications of essential hypertension. Even with the advent of newer antihypertensive agents, including angiotensin-converting enzyme inhibitors and calcium antagonists, the centrally acting sympatholytics (alpha 2-adrenoceptor agonists) remain a valuable group of medications for the management of hypertension of all grades of severity. Their advantages include efficacy; rarity of contraindication; absence of most metabolic and serious side effects; favorable effects on systemic hemodynamics; lack of true tolerance and infrequency of volume expansion-related pseudotolerance; suitability in the elderly, in isolated systolic hypertension, and in patients with various concomitant conditions, such as diabetes mellitus; ability to reverse left ventricular hypertrophy; and relative low cost. The long duration of action of guanfacine hydrochloride, the most recently marketed agent, and of the transdermal formulation of clonidine is an especially commendable feature. The principal disadvantages of this class of medications are an overlap between the therapeutic dosage and that producing sedation and dry mouth and the potential to cause the discontinuation syndrome and sexual dysfunction.
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PMID:Use of centrally acting sympatholytic agents in the management of hypertension. 187 68


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