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

Recent studies have now demonstrated that it is more important to focus on the SBP level than the DBP level in older persons. In addition, recent studies indicate that persons over age 80 still derive substantial benefit from treating ISH or DH. Also, studies now show that low-dose diuretics have a more favorable impact on subsequent coronary heart disease rates than was previously demonstrated. Finally, although caution is urged, it is unlikely the J-shaped relationship between treated DBP or SBP and subsequent mortality is due to overly aggressive treatment of high blood pressure. Table 4 provides the authors' guidelines for treating older persons with high blood pressure.
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PMID:Advances in management of hypertension in older persons. 846 45

Despite the great therapeutic advances, the control of hypertension in populations is far below the achievable level, even in populations with highly developed health care. By the end of the 1980's, in selected European centres, 18-34% of cases of hypertension were undetected, and among those previously known, 22-38% were untreated. The cooperative WHO/WHL Hypertension Management Audit Project aimed at assessing some of the impediments to better control of hypertension. The concepts and attitudes of 2,215 physicians were surveyed. In various centres and at various patient ages, 25-45% of physicians would not start drug treatment below 100 mm Hg. When inquiring into the perceived reasons why hypertension had not been detected earlier, among other reasons, physicians tended to incriminate their workload, while patients often felt that there was a lack of interest on the doctor's part to take a blood pressure reading. In general, patient satisfaction seemed suboptimal. Physician's sources of information were varied; neither WHO, nor ISH or WHL seemed to play an important role in informing the physicians.
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PMID:Impediments to the control of hypertension. Hypertension Management Audit Group. 154 Oct 37

The three papers reviewed for this issue deal with unrelated aspects of hypertension, illustrating the broad range of questions that still exist about optimal diagnosis and management. Physicians have for years been unsure about the efficacy, safety, and impact on morbidity of treating ISH. The result of these concerns has been that many, if not most patients with ISH never received treatment. The SHEP data are a powerful argument for routine treatment of ISH, which would represent a new standard of care for this condition. Only clinical experience and future trials will indicate whether treatment of ISH in the general population will be accompanied by the low incidence of side effects and morbidity observed in the more highly selected population of the SHEP trial. The study of Zeller et al. adds to the evidence that less is more, or at least the same, when it comes to treatment of hypertensive urgencies. The practice of oral 'loading' doses was not shown to improve therapeutic results. It is still not completely clear what criteria physicians should use in making a decision about inpatient parenteral therapy versus outpatient oral therapy. In patients with evidence of acute onset and end-organ injury, it is probably prudent to admit. In the absence of these risk factors, institution of an outpatient oral antihypertensive regimen can probably be accomplished with safety and at dramatically lower cost. The study of Koren et al. demonstrated a marked additional risk when LVH was present in hypertensive patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Selections from current literature: treatment of hypertension. 163 20

ISH is a distinct pathogenetic entity defined by SBP readings of greater than or equal to 160 and DBP less than 90 mmHg. The etiology, although not well understood, is in some manner related to a reduction in connective tissue elasticity of large blood vessels and an increase in aortic impedance or a decrease in aortic wall compliance. The pathophysiologic consequences include an increased resistance to systolic ejection of blood and a disproportionate increase in SBP. Although not directly related, there is an important increase in peripheral vascular resistance. The prevalence of ISH in several studies is about 7 percent in those over age 60 and increases with age to nearly 20 percent in those over age 80. There is higher prevalence in females and nonwhites. The guidelines for detection of ISH are similar to those for blood pressure evaluation in general. Precautions for detection and evaluation in the elderly include multiple blood pressure measurements in the fasting state and sitting and supine blood pressure measurements before and during therapy. Pseudohypertension, although rare, should be kept in mind. There is a clear risk associated with ISH for stroke, CVD, and premature death, which increases with age and rising levels of SBP. ISH can be controlled effectively with pharmacologic therapies. A reasonable goal is a 20 mmHg reduction in systolic pressure. Proof of reduced risk for stroke, CHD, and death in those with controlled ISH remains to be demonstrated. The SHEP pilot study has demonstrated feasibility of addressing this issue. The full-scale SHEP study addresses this issue and has completed recruitment of the desired sample size and is in follow-up phase. Scheduled completion is in 1991. While we wait for the SHEP full-scale trial results, the prudent approach is for nonpharmacologic therapy and use of pharmacologic agents in that group of patients who demonstrate a large cardiovascular risk burden or increasing symptoms specifically associated with hypertension. The decision to treat must be on an individual patient basis. Pharmacologic therapy is possible in most patients with few or no adverse effects. The "low and slow" approach to therapy is helpful in minimizing these adverse effects. Low-dose diuretics have been documented to be effective in blood pressure control. Chlorthalidone, 12.5 or 25 mg per day, is suggested. Other agents, such as beta-blockers, reserpine, ACE inhibitors, and calcium channel blockers, are best used as Step 2 agents.
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PMID:Systolic hypertension in the elderly: controlled or uncontrolled. 218 67

The present guidelines were prepared by a subcommittee of the WHO/ISH (International Society of Hypertension) Mild Hypertension Liaison Committee, and wee finalized after discussion at the Fifth WHO/ISH Mild Hypertension Conference. They include the definition of mild hypertension, and describe blood pressure measurement, factors influencing the decision to begin treatment, methods of treatment, and follow-up. These guidelines are a revision of those published in 1986; they are based on the best available scientific evidence, and will be updated in the future to keep abreast of further developments in this field.
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PMID:1989 guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting. 261 74

In the Region Veneto, north-eastern Italy, a survey of three random samples of population aged 20-64 has been made during the initial phase of the international cooperative pilot project called "Community Control Programme of Hypertension", promoted by World Health Organization. 15,187 subjects were examined (47.2% males). The prevalence of "isolated" systolic hypertension (ISH: "casual" blood pressure at or above 160 for systolic readings and below 95 for diastolic) was 6.2%, that of "isolated" diastolic (IDH) 9% and that of "simultaneous" systolic diastolic hypertension (SDH) 15.5%. ISH had an awareness rate of 29.4% and a treatment rate of 10.6%, which is less than for SDH but more than IDH. Analysis of the Hypertension Register set up in one of the three areas showed no important differences in heart rate, Body Mass Index, serum sodium or potassium, B.U.N. and total cholesterol between the different forms of hypertension. The assessment of coronary risk by means of Multiple Logistic Function yielded similar figures for ISH and SDH in males, higher figure for SDH in females. Electrocardiographic changes of left ventricular hypertrophy and of ischaemia were more frequent among subjects with ISH than those with SDH and IDH. It is concluded that ISH is present in a substantial proportion of the population and carries with it no less risk of cardiovascular complications than the other forms of hypertension.
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PMID:Isolated systolic hypertension in the community. Data from a population survey and hypertension register in Northern Italy. 698 70

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

Basing on the prevalence survey, 94 cases were diagnosed as simple senile systolic hypertension and 67 cases as non simple senile systolic hypertension, and 136 persons with normal blood pressure were sampled as control. Two case-control studies were conducted, then the etiologic factors of two types of hypertension were compared. Among age, sex, smoking, drinking, mental incidence, family history of hypertension, body height, body weight, body weight index, blood sugar, TC, TG, HDL-c, etc., a total of 18 factors, mono variate unconditional logistic regression analysis showed that the occurrence of ISH associated with age, family history of hypertension, mental incidence and blood sugar, and that the risk factors of NISH were body weight index, body weight, smoking, drinking, mental incidence, and TC. Further multi-unconditional logistic regression turned out that mental incidence, family history of hypertension and blood sugar entered the model of ISH, and that the body weight index, smoking, mental incidence, blood and TC entered the model of ISH. The study showed that the etiologic factors of ISH differed from those of NISH, which was a syndrome differed from NISH.
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PMID:[A study on the difference of etiology between two types of hypertension in old people]. 808 36

The present guidelines were prepared by the Guidelines Sub-Committee of the WHO/ISH (International Society of Hypertension) Mild Hypertension Liaison Committee. They represent the third revision of the WHO/ISH guidelines and were finalized after discussions at the Sixth WHO/ISH Meeting on Mild Hypertension in Chantilly, France, on 28-31 March 1993. The new guidelines discuss the cardiovascular risk in patients with hypertension, the definition and classification of mild hypertension, drug treatment (including the elderly) and non-drug measures, cost-effectiveness, and further research.
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PMID:1993 guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting. 826 54

To determine whether insertion/deletion (I/D) polymorphism (intron 16) of the angiotensin converting-enzyme (ACE) gene is associated with isolated systolic hypertension (ISH: systolic blood pressure (BP) > or = 160, diastolic BP < 90 mm Hg) or systolic-diastolic hypertension (S-D hypertension: diastolic BP > or = 90 +/- systolic BP > or = 160 mm Hg) compared with normotensive controls (systolic BP < 160, diastolic BP < 90 mm Hg), we conducted a case-control study of 733 non-institutionalised, elderly (> or = 60 years) residents of Dubbo, NSW. Individuals were classified as: ISH (n = 167), S-D hypertension (n = 207) and normotensive control (n = 359) with age and sex matching. II, DD and ID genotypes were determined by a nested PCR strategy using DNA extracted from serum. The frequencies of D and I alleles in the control population (0.70 and 0.30 respectively) were not significantly different in the ISH group or the S-D hypertension group (chi 2: 1.7, P = 0.42). After adjustment for several potential confounders, neither genotype nor allele predicted ISH (II vs DD: odds ratio (OR): 1.06, 95% confidence interval (CI): 0.55-2.03; I vs D: 1.09, 0.82-1.46) or S-D hypertension (II vs DD: 1.19, 0.67-2.10; I vs D: 1.16, 0.89-1.52) in this elderly cohort. The I/D polymorphism of the ACE gene is not a marker for either form of hypertension in this large elderly sample.
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PMID:I/D polymorphism of the angiotensin-converting enzyme gene does not predict isolated systolic or systolic-diastolic hypertension in the elderly. 873 34


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