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

Blood pressure levels increase with age. So, the prevalence of both isolated systolic (systolic pressure greater than 160 mmHg and diastolic less than 90 mmHg) and diastolic hypertension (diastolic pressure greater than 95 mmHg) in the elderly is high. Due to high variability of blood pressure and to overestimation of real blood pressure when arterial walls are sclerosed, the true prevalence of hypertension is probably overestimated. Nevertheless, like in younger persons, hypertension in elderly is a major risk factor of cardiovascular morbidity and mortality. Results of clinical trials designed in the last 30 years have clearly proved benefit of antihypertensive therapy. However, a lot of questions remain: Is treating hypertension justified in the very old? Has isolated systolic hypertension to be treated? Which antihypertensive drugs may be used? Is screening for atherosclerotic renovascular disease useful? Which investigations have to be performed for diagnosing atheromatous renal failure?
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PMID:[Hypertension in the aged person. Numerous questions, few responses]. 209 Sep 62

It is generally accepted that increased blood pressure, especially high systolic blood pressure, is a major risk indicator in people over 60 years of age. Retrospective analyses of published trials show that when the elevation in arterial pressure has been firmly established by repeated blood pressure measurements, antihypertensive treatment should be considered for the following subgroups. (1) All elderly hypertensive patients with grade III or IV retinopathy, congestive heart failure or cerebral infarction or hemorrhage should be treated regardless of age or degree of blood pressure elevation. (2) In elderly patients with established mild hypertension and no symptoms or complications, non-pharmacological treatment should be started in patients less than 80 years of age, with antihypertensive drugs prescribed if diastolic pressure reaches 100 mmHg or more over 3 months or 95 mmHg or more over 6 months of follow-up. The therapeutic benefit of pharmacologic antihypertensive treatment has not yet been established in hypertensive patients over 80 years of age or in those with isolated systolic hypertension. All things considered, the indication to intervene pharmacologically should be viewed as becoming gradually more compelling as blood pressure rises. The more closely a patient's characteristics match those of a subset of elderly hypertensive patients in whom therapeutic benefit has been proven, the greater the need for pharmacologic treatment.
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PMID:Treatment of the elderly hypertensive patient. 214 7

Clinical, electrocardiographic and echocardiographic findings of 69 subjects aged 80 years or over were analyzed in order to assess the prevalence of left ventricular mass, hyperlipidemia, hypertension and cigarette smoking. Of the 69 subjects studied, 41 had no symptoms or sign of cardiovascular disease, 28 had one or more cardiac symptoms (NYHA stage 2-4). 25 had electrocardiographic evidence of left ventricular hypertrophy and there were no differences between the asymptomatic and symptomatic groups. Echocardiographically, the left ventricular mass index ranged between 103 to 247 g/m2 in men and 170 to 251 g/m2 in women. In 36 subjects with high left ventricular mass index, the ventricular septal thicknesses ranged from 12 mm to 15 mm in 19 subjects, and posterior wall thicknesses ranged from 12 mm to 16 mm in 17 subjects. Of the 58 patients with an adequate echocardiogram, 47 had clinically diagnosed hypertension (81%). In our study population, a prevalence of left ventricular hypertrophy (62%), isolated systolic hypertension (26%), definite hypertension (33.3%), high LDL-cholesterol (63%), low HDL-cholesterol (26%), abnormal Q wave (16%), cigarette smoking (47.8%) and diabetes mellitus (1.4%) were found.
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PMID:Left ventricular mass index and prevalence of heart disease in the population aged 80 years and over. 214 63

Mild hypertension is very common, 50% of hypertensives being with their diastolic BP between 90 and 104 mmHg. Many large studies, especially HDFP, had shown not only the deleterious cardiovascular effects of mild hypertension but also the benefits obtained with the therapy. The non-pharmacological approach should be the first step in the treatment of mild hypertension. Isolated systolic hypertension have a high prevalence in the elderly, increasing the cardiovascular morbidity and mortality. Sodium restriction and, if necessary, vasodilators increasing the arterial compliance seem to be the logical approach to treat isolated systolic hypertension. Finally, eclampsia is the most serious complication of pregnancy - induced hypertension. The treatment with bed rest and either betablockers or methyldopa is beneficial. If eclampsia occurs hydralazine, magnesium sulphate or nifedipine should be used.
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PMID:[Arterial hypertension in special situations: mild, systolic and in pregnancy]. 218 54

More than half of elderly men and women have hypertension, leading to a significant risk of increased morbidity and mortality. The cause of hypertension in this age group is unknown. Left ventricular hypertrophy is frequently present, often associated with diastolic dysfunction. Systolic hypertension in the elderly increases the risk of cardiovascular disease, but there are no good data to show that the treatment of isolated systolic hypertension reduces the morbidity or mortality. Good evidence indicates that antihypertensive treatment in this group decreases cardiovascular morbidity and mortality up to age 80, so most elderly hypertensive patients should be treated. An empiric trial of nonpharmacologic therapy can be initiated in those with mild hypertension and no cardiovascular disease, but most patients will require drug therapy. Most elderly hypertensive patients have accompanying illnesses for which they may or may not be taking medications. Some antihypertensive drugs exacerbate coexisting diseases while others augment treatment regimens. Similarly, drugs may interact in a beneficial or adverse way. Finally, drug metabolism is altered by age, leading to problems with toxicity or diminished efficacy. The choice of medication should be based on all such considerations, including the cost and convenience of the drugs available.
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PMID:Perspective on hypertension in the elderly. 219 Apr 14

Hypertension, both combined diastolic plus systolic and isolated systolic, is common in the elderly. Elderly hypertensive patients pose a number of diagnostic dilemmas, including pseudohypertension, postural and postprandial decreases in blood pressure, and the potential for renovascular hypertension. Data from large clinical trials have documented protection from cardiovascular complications by antihypertensive therapy for elderly people with combined systolic and diastolic hypertension. However, no data are available concerning the value of therapy for those with isolated systolic hypertension. Until such data become available from the Systolic Hypertension in the Elderly Program in 1991, cautious reduction of elevated systolic blood pressure levels is recommended. The fragile physiologic characteristics of the elderly demand caution and gentleness in the use of any therapy to lower blood pressure. Nondrug therapies are safe and may be effective. A variety of drugs are available and can be used to gradually reduce blood pressure to presumably safer levels.
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PMID:Treatment of hypertension in the elderly. 219 53

Hypertension is a common problem in the elderly with a prevalence approaching or exceeding 50%. The risk of cardiovascular disease and death is increased in elderly hypertensives aged 60-74 years, whereas this increased risk seems to be diminished or even nonexistent in those aged 75 and above. Hypotensive drug treatment has been shown to be beneficial for the younger elderly patients, but whether or not this is also true for the older elderly hypertensives is less clear. Isolated systolic hypertension increases the cardiovascular risk, but we lack data on the efficacy of treatment in this group.
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PMID:Hypertension and ageing. 220 47

After successful repair of coarctation of the aorta in childhood, exercise-induced upper body systolic hypertension is well documented. Beta blockade has been shown to reduce the arm/leg gradient in untreated coarctation of the aorta; treatment before coarctation repair has decreased paradoxical hypertension after repair. Ten patients with successful surgical repair of coarctation, defined as a resting arm/leg gradient of less than or equal to 18 mm Hg, were evaluated by treadmill exercise before and after beta blockade with atenolol. Mean age was 5.5 years at repair and 18 at study. At baseline evaluation, systolic blood pressures at termination of exercise ranged from 201 to 270 mm Hg (mean 229 mm Hg). Arm/leg gradients at exercise termination ranged from 30 to 143 mm Hg (mean 84). Follow-up treadmill exercise studies were performed after beta blockade. Upper extremity systolic pressures at exercise termination were normalized in 9 of 10 patients. Maximal systolic blood pressure recorded at exercise termination ranged from 163 to 223 mm Hg (mean 196 mm Hg, p less than or equal to 0.005). Arm/leg gradient at termination of exercise also decreased significantly to a mean of 51 mm Hg (p less than 0.05). No patient had symptoms on atenolol and exercise endurance times were unchanged. The study results in this small series suggest that cardioselective beta blockade can be used to treat exercise-induced upper body hypertension effectively after surgical repair of coarctation. Because a high incidence of premature cardiovascular disease has been well documented after satisfactory surgical repair, the findings are of importance for this group of postoperative patients.
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PMID:Atenolol therapy for exercise-induced hypertension after aortic coarctation repair. 223 28

The relationship between body weight excess and hypertension has been widely demonstrated. Some body-builders can reach an important body weight excess because of the skeletal muscle hypertrophy; their body mass index is comparable to that of obese subjects, although body fat excess is responsible for overweight in the latter. Blood pressure, fasting plasma glucose and insulin, Na+, K+, Ca++ urinary excretion have been compared in three groups of young males: 1. body builders with BMI greater than 27; 2. obese subjects with BMI greater than 27; 3. normal subjects with BMI less than 25. Systolic blood pressure was similar in body-builders and obese and significantly higher than in the control group. Diastolic blood pressure, fasting plasma glucose and insulin were similar in normal subjects and in body-builders and significantly lower than in obese subjects. Although our results confirm the relationship between increased diastolic blood pressure, hyperinsulinemia and body fat excess, the finding of increased systolic blood pressure suggests caution in body-building, because systolic hypertension has been demonstrated to be a risk factor for vascular diseases.
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PMID:[Comparative assessment of arterial blood pressure and body composition in athletes practicing physical culture and in obese subjects]. 227 25

Blood pressures of 1682 elderly peasants in Chengdu were measured at cluster random. The prevalence rate of hypertension was 15.7% and higher than that in early elderly (P less than 0.01). The rate of systolic hypertension was 75.4% and increased with the increase of age. The rate in females was higher than that in males (P less than 0.01). Electrocardiograms of these hypertension persons were analyzed with Minnesota code, and the incidence rates of two types were not statistically significant. These results show that the change of heart function resulted from hypertension is related with the rise of systolic pressure as well the rise of diastolic pressure.
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PMID:[A report on systolic hypertension in 1682 elderly peasants in Chengdu area]. 232 45


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