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

A new WHO Expert Committee Report on Hypertension Control has recently been prepared. This paper is not intended to be a detailed summary of this report. It rather intends to identify the principal issues where the new report differs from the previous 1978 WHO report, to point out the aspects where it has substantially incorporated the recommendations made on the 1993 WHO/ISH guidelines, and to mention the issues that have been developed in this report more extensively than in previous WHO or WHO/ISH documents.
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PMID:The new WHO Expert Committee Report on Hypertension Control. 874 28

The objectives of hypertension control include early detection, treatment and prevention of blood pressure (BP) elevations. In clinical situations, continuous evaluation of an Individual's treatment is an inherent part of normal follow-up. On the level of populations, however, evaluation of hypertension control calls for specially designed action. Evaluation is needed for several reasons; these are, inter alia, strategic (to improve the method); economic (to upgrade cost-effectiveness); and ethical reasons (to morally justify public action). Since hypertension control in populations is itself a complex process, its evaluation requires, multidimensional approaches. The methodologic experience from three WHO studies of this kind has been reported. These were done in different contexts: (1) evaluation of the effects of a special multicentre programme for hypertension control in populations; (2) long-term monitoring of cardiovascular disease incidence; and (3) a project for the assessment of levels and quality of hypertension control that is taking place spontaneously. In the first study, changes with time were compared in pairs of similar communities, of which one had been exposed to an organized programme for the control of hypertension ('intervention' vs 'reference' community). The second study uses an elaborate system of disease registers and surveys periodically a number of general populations. In the third study the actual level and quality of hypertension control was analysed in different, mostly European, populations; the findings related to the treatment of hypertension were compared with the standards suggested by WHO and ISH; other findings were assessed on the basis of common sense.
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PMID:Assessing the quality and effects of hypertension control in populations. 887 16

Uncertainty still remains regarding the differing effects of blood pressure and age on baroreceptor-cardiac reflex sensitivity in elderly individuals; these differences are at least partly due to the differing methods and subject groups used in previous studies. We sought to resolve these issues by examining baroreflex sensitivity in 54 subjects aged 70 +/- 1 years (mean +/- SE; range, 60 to 81) divided into groups with combined systolic-diastolic hypertension (CH group, n = 16), isolated systolic hypertension (ISH group, n = 16), or normotension (NT group, n = 22). Baroreflex sensitivity was quantified from the pulse interval and blood pressure responses to the Valsalva maneuver and pressor (phenylephrine) and depressor (sodium nitroprusside) stimuli. Baroreflex sensitivity was significantly reduced in the two hypertensive groups but did not differ between them (Valsalva maneuver: CH group, 1.9 +/- 0.3 ms/mm Hg; ISH group, 2.8 +/- 0.5; NT group, 4.4 +/- 0.4; phenylephrine: CH group, 3.1 +/- 0.6; ISH group, 3.5 +/- 0.7; NT group, 7.7 +/- 1.0; sodium nitroprusside CH group, 2.1 +/- 0.3; ISH group, 3.6 +/- 0.8; NT group, 5.4 +/- 0.3; all P < .05 for comparison with the NT group). Thus, this study demonstrated reductions in baroreflex sensitivity with hypertension in elderly subjects consistent across all methods but with no difference between subjects with combined hypertension and isolated systolic hypertension matched for similar systolic pressure. Baroreflex sensitivity was related only to the level of systolic pressure independent of diastolic pressure or age. If elderly subjects with isolated systolic hypertension have a greater reduction in large-artery compliance than combined hypertensive subjects with similar systolic pressure, this does not appear to lead to further reductions in baroreflex sensitivity in these individuals.
Hypertension 1996 Dec
PMID:Arterial baroreceptor-cardiac reflex sensitivity in the elderly. 895 82

Diuretics were used in most of the major trials that demonstrated that lowering the blood pressure reduced cardiovascular morbidity and mortality. Nevertheless in the second half of the eighties, there were misgivings about the widespread use of thiazide diuretics, driven in part by the relative failure of the large trials to reduce myocardial infarction-to the extent predicted by large scale epidemiological studies. There was much attention on metabolic side effects of thiazide diuretics including dyslipidaemia, glucose intolerance, hypokalaemia, hyperuricaemia, and then microalbuminuria particularly in diabetic subjects. These issues were current when JNC (IV) (1988) and the WHO-ISH guidelines (1989) were being written. Three major clinical trials SHEP, STOP and MRC published in the early nineties established that thiazide diuretics alone, or in combination with beta blockers, did reduce cardiovascular morbidity and mortality in elderly subjects with hypertension. All guidelines published since 1993 include diuretics among the first line drugs. Possibly the most important factor in the restoration of diuretics has been the use of progressively lower doses that minimise the metabolic side effects. Diuretics are effective as monotherapy in the treatment of mild essential hypertension and of isolated systolic hypertension in elderly subjects. They are very useful in combination with beta blockers or with ACE inhibitors. They should be avoided in patients with gout and should not be used as first line drugs in patients with diabetes. They should only be used with caution in young obese subjects with dyslipidaemia and increased risk of coronary artery disease, facing many decades of treatment for hypertension. However there is no doubt that diuretics are effective, cheap and have a central role in the control of hypertension in all communities around the world.
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PMID:[Role of diuretics in the treatment of hypertension: from large controlled trials to international guidelines]. 895 12

The categorical term "auditing" hypertension control is chosen on purpose, to emphasize the responsibility of health politicians for assessing the quality and effects of interventions in populations. Auditing of hypertension is needed for reasons of Efficacy, Economics and Ethics. An analysis of efficacy should test whether the local strategies of hypertension control are sufficiently adapted to the needs and characteristics of a given population. Economic analyses should consider hypertension control in the perspective of resources and priorities. The ethical imperative requires an assessment and follow-up of the effects of health measures on the population, by the same token as evaluation of treatment results is obligatory in clinical medicine. The WHO/WHL Hypertension Management Audit Project was an attempt to analyze the repercussions of hypertension control programs on selected population. Five approaches were taken: (i) assessment of the epidemiological situation; (ii) clinical analysis on a sample of patients; (iii) assessment of patient satisfaction and of (iv) physicians' knowledge and attitudes; and (v) drug utilization studies. The results showed (a) a mixture of under- and overdiagnosis of hypertension in populations; (b) undertreatment of various degrees; (c) mixed patient satisfaction; (d) partial compliance of physicians' concepts and attitudes with standards promulgated by WHO and ISH; and, (e) great differences (at the time of the study) between drug utilization patterns in different countries.
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PMID:Auditing hypertension control and management: a position paper. 896 83

Data regarding the tolerance of ACE inhibitors in old age are sparse, despite this class of compound being regarded as one of the first-line agents for the treatment of hypertension. In the present trial, the efficacy and tolerance of the ACE inhibitor fosinopril was examined over a period of 12 weeks in an open trial of hypertensive patients aged over 60 years with diastolic hypertension (diastolic blood pressure 95 to 110 mm Hg) and isolated systolic hypertension (ISH; systolic blood pressure 160 to 219 mm Hg, diastolic blood pressure 80 to 94 mm Hg). Fosinopril decreased blood pressure from 174/101 mm Hg to 149/88 mm Hg in patients with diastolic hypertension and from 182/86 mm Hg to 151/80 mm Hg in patients with ISH. Seventy percent of patients did not require any adaptation of the initial fosinopril dose to achieve an adequate therapeutic response. In the patients in whom 20 mg fosinopril did not adequately reduce blood pressure, the addition of 12.5 mg hydrochlorothiazide was found to be slightly more effective than doubling the initial dose of the ACE inhibitor. Fosinopril was well tolerated and the occurrence of drug-dependent side effects was not increased in patients with renal insufficiency. Fosinopril is an excellent therapy for the treatment of hypertension in elderly patients, particularly because, as a consequence of its dual, compensatory excretion, no adaptation of the dose is necessary, even in patients with a physiological reduction in renal function.
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PMID:Treatment of senile hypertension: the Fosinopril in Old Patients Study (FOPS). 936 82

1. Using a nested case-control study of 661 non-institutionalized elderly (> or = 60 years) residents of Dubbo, New South Wales, Australia, the aim of this study is to determine whether the A1166C polymorphism of the angiotensin II type I (AT1) receptor gene is associated with hypertension in the elderly. 2. Individuals were classified as isolated systolic hypertension (ISH, n = 146), systolic diastolic hypertension (SDH, n = 188), or normotensive, age- and sex-matched controls (n = 327). AA, CC and AC genotypes were determined using restriction fragment length polymorphism analysis of DNA generated by nested polymerase chain reaction. 3. A univariate analysis (chi 2) was complemented by a logistic regression analysis, facilitating adjustment for potential confounders. The unadjusted genotype and allele frequencies in ISH or SDH subjects did not differ significantly from the control subjects (chi 2 = 3.0, P = 0.55, 4 d.f.; chi 2 = 3.0, P = 0.23, 2 d.f., respectively). After adjustment for potential confounders neither genotype nor allele predicted ISH or SDH in this cohort. 4. From this study we conclude that the A1166C polymorphism of the AT1 receptor gene is not a marker for ISH nor for SDH in this large, elderly community sample.
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PMID:The A1166C mutation in the angiotensin II type I receptor and hypertension in the elderly. 1040 80

A 1990-91 country-wide survey in Nigeria showed the prevalence of hypertension to be 11.2% in those aged 15 years and above. The management, however, has been shown to be inadequate. At the instance of the Nigerian Hypertension Society a Consensus Meeting of National Medical Societies and other interest groups produced in 1996 Guidelines for the Management of Hypertension in Nigeria. Medical societies and the pharmaceutical industry have tried to increase awareness of the condition and its control through lectures, seminars, sponsor of essay competitions among secondary school and university students as well as canvassing against cigarette advertising and smoking in public places. However, their efforts are thwarted by luring advertisements by multinational tobacco companies driven from developed countries by anti-tobacco lobbies and legislation. A questionnaire survey showed that no other African country had produced similar guidelines in the past five years. In Sub-Saharan Africa there appears to be negligible implementation of the WHO-ISH Guidelines.
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PMID:WHO-ISH Guidelines for the management of hypertension: implementation in Africa--the Nigerian experience. 1042 91

The WHO-ISH Guidelines on Hypertension have been introduced in India but their implementation has not been systematically studied. The process of implementation of international guidelines involves several steps: (a) recognition of the guidelines by the national opinion makers (b) acceptance, adaptation and adoption of the guidelines by the main change agents (c) initiation of guidelines in healthcare practice by the trend setters (d) advocacy of the guidelines by the influential change agents (e) dissemination of guidelines across various levels of health care and (f) diffusion into routine health care practice. The previous WHO-ISH Guidelines had inadequate impact due to limitations at each of these levels. The implementation of the new guidelines in developing countries, such as India, requires a concerted campaign of social marketing involving partnerships of key stakeholders.
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PMID:Implementation of international guidelines on hypertension: the Indian experience. 1042 93

The present Guidelines were prepared by the Guidelines Sub-Committee of the World Health Organization-International Society of Hypertension (WHO-ISH) Mild Hypertension Liaison Committee, the members of which are listed at the end of the text. These guidelines represent the fourth revision of the WHO-ISH Guidelines and were finalised after presentation and discussion at the 7th WHO-ISH Meeting on Hypertension, Fukuoka, Japan, 29th Sept-1st Oct, 1998. Previous versions of the Guidelines were published in Bull WHO 1993, 71:503-517 and J Hypertens 1993, 11:905-918.
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PMID:1999 World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. 1042 21


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