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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

The blood pressure response to dynamic exercise was studied in 90 adolescents (45 males and 45 females) mean age 15 years (range 13-16 years) with casual systolic and/or diastolic hypertension (H) and in 50 matched for age adolescents (26 males and 24 females) with casual blood pressure about the fiftieth percentile for age and sex (N). During the third blood pressure control they underwent a maximal bicycle exercise test in sitting position (10 W/min). During exercise and recovery ECG was recorded every 30 s and blood pressure, with a mercury sphygmomanometer, every 3 min. Adolescents with casual hypertension at rest showed, in comparison to normotensives, an increase in blood pressure (H: 176.1 +/- 18.8 mmHg; N: 167.4 +/- 14.2 mmHg, p less than 0.01 at peak of exercise) and in rate-pressure product (H: 326.8 +/- 40.9 X 10(-2); N: 308.7 +/- 29.4 X 10(-2); p less than 0.01 at peak of exercise) during exercise and recovery. Heart rate was greater at rest in hypertensive adolescents, but there was no difference between the 2 groups during exercise. Exercise tolerance was similar in the 2 groups. Casual transient hypertension at rest and excessive increase of systolic blood pressure during exercise could be expression of early cardiovascular changes preceding sustained hypertension.
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PMID:[Cardiovascular response to dynamic physical exercise in adolescents with casual raised values of arterial blood pressure]. 209 29

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

Systolic or diastolic hypertension, cigarette smoking, diabetes mellitus, left ventricular hypertrophy, age, prior stroke, transient cerebral ischemic attack, extracranial arterial disease, and coronary heart disease are risk factors for the most common type of geriatric stroke, atherothrombotic brain infarction (ABI). Also, by contributing to hypertension and diabetes mellitus, obesity predisposes to ABI. The relationship of abnormal serum lipids and of physical inactivity to ABI is unclear. Antihypertensive treatment decreases the incidence of fatal and nonfatal stroke in patients with systolic and diastolic hypertension. Cessation of smoking also decreases risk.
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PMID:Risk factors for geriatric stroke: identification and follow-up. 220 86

Long-term clinical trials of antihypertensive therapy have demonstrated that diuretic-based therapy consistently reduced fatal and non-fatal cerebrovascular events regardless of age, race or gender; the frequency of ECG left ventricular hypertrophy, retinopathy and progression of hypertension were also reduced, and cardiomegaly and ECG left ventricular hypertrophy were reversed. A case can be made for initiating antihypertensive therapy whenever diastolic blood pressure remains greater than or equal to 90 mmHg despite a fair trial of non-pharmacologic treatment. Elderly patients with diastolic hypertension benefit from diuretic-based therapy at least until the age of 80 years. Whether ACE inhibitors or calcium channel blockers are more effective than diuretics in preventing cardiovascular complications remains to be seen. So far, there have been no long-term trials using these agents as initial therapy.
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PMID:Long-term clinical trials in hypertension. 221 83

There is not increasing evidence that, from an epidemiological stand-point, treatment of diastolic hypertension in the elderly leads to a significant cardiovascular risk reduction; however, for the individual patient, the magnitude of absolute risk reduction is relatively small. More widespread use of ambulatory blood pressure recording is suggested in order to improve patient selection - i.e. to avoid antihypertensive treatment in patients with white coat hypertension - and to prevent overtreatment in patients with established hypertension. This strategy should result in a selection of elderly, hypertensive patients who are more likely to benefit from pharmacological treatment and thus restrict the number of patients needing treatment for prevention of a cardiovascular complication. Furthermore, by decreasing the risk of overtreatment, this strategy is likely to result in a decrease in the number of medication-related side effects such as coronary morbidity and mortality.
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PMID:[Treatment of arterial hypertension in the elderly person: unresolved problems]. 221 20

The role of aging, hypertension and plasma cholesterol in the development of coronary atherosclerosis was examined in 3569 consecutive autopsy cases, aged 60 to 99 years, at the Tokyo Metropolitan Geriatric Hospital. The prevalence of coronary atherosclerosis increased with aging. Both systolic and diastolic hypertension were related to the prevalence of coronary atherosclerosis. High plasma cholesterol (230 mg/dl) was related to increased prevalence of coronary atherosclerosis. This effect was observed in a hypertensive group, but not in a normotensive group. To define the effect of hypertension on vascular diseases, endothelial cells from spontaneously hypertensive rats (SHR) were obtained and characterized in terms of cellular response. Cellular Ca2+ level in response to A23187 was significantly enhanced in SHR compared to normotensive Wistar-Kyoto rats (WKY). Thus, aging, hypertension and high plasma cholesterol are risk factors for coronary artery atherosclerosis in the elderly.
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PMID:[Development of coronary atherosclerosis in the elderly]. 223 9

Arterial hypertension (HA) is a public health problem, 15 to 30% of adults in our country suffer it. There are different facts that influence its outcome. Among young people the main factors are: alcoholism, smoking tobacco, overweight, diabetes, family history, sedentarism and psychological aspects. The main object of this study, was to detect the risk factor for the development of HA in the students of the University. For this search 489 sophomore students class at the Medical School of the University of Mexico (UNAM), between 17 and 24 years old, were studied. Our results showed that positive family history was more prevalent among females. Among males life-style factors were more significant, the main factor was sedentarism, whereas lesser factor was overweight. The prevalence of HA was higher for diastolic hypertension than for systolic. We concluded there are many risk factors that influence the development of HA, which are distributed in a different way according to gender preventive measures are recommended.
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PMID:[Life style, family history and personal pathology in relation to arterial hypertension in students of the Medical Faculty of UNAM]. 224 2

Fifty-six patients with severe hypertension were treated with intravenous nicardipine for infusion periods of eight to twenty-four hours. Each patient achieved satisfactory blood pressure control during the infusion period with a mean controlling dose of 7.85 mg/hr. The dose of nicardipine needed for sustained blood pressure control correlated with untreated diastolic blood pressure but not with untreated systolic blood pressure. These results demonstrate the potential usefulness of intravenous nicardipine for the treatment of severe hypertension requiring rapid lowering, and they suggest also that the severity of pretreatment diastolic hypertension might be a useful indicator of the dose required for blood pressure control.
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PMID:Intravenous nicardipine: an effective new agent for the treatment of severe hypertension. 224 22

Ketanserin is the prototype of a new class of antihypertensive drugs based on a selective blockade of serotonin S2 receptors. A number of controlled trials have indicated that ketanserin is more effective in older than in younger subjects and that, in the elderly, ketanserin may be even more effective than other antihypertensive drugs. We set up a large multicenter trial to compare the two most common dosages of ketanserin (20 mg and 40 mg twice daily) in patients of 60 years of age and over. In these patients, blood pressures were elevated systolically (SBP greater than or equal to 160 mmHg), diastolically (DBP greater than or equal to 95 mmHg), or both, and any existing antihypertensive medication was continued at a constant dosage. The total duration of the trial was 3 months and monthly control visits were held. Throughout the Netherlands, 252 general practitioners participated in the trial, which included 462 evaluable patients. After 1 month of open treatment with 20 mg ketanserin twice daily, blood pressure was found to be fully normalized in 18% of patients, while the proportion of patients with both systolic and diastolic hypertension was reduced from 89% to 50%. In three out of four patients, an adequate and maximal fall in blood pressure was reached only after 2-3 months of treatment. In such patients, raising the ketanserin dose from 20 mg to 40 mg twice daily did not result in any faster or improved antihypertensive response. A number of symptoms related to peripheral circulatory disturbances, or possibly to hypertension itself, markedly improved during oral treatment with ketanserin.
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PMID:Oral dosing with ketanserin to control high blood pressure in the elderly. 228 39


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