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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There has been a continuous evolution in hypertensive therapy during the last 30 years. Now, physicians have access to more than 40 agents for treating this widespread condition. Large-scale clinical trials have established that lowering blood pressure in patients with mild to moderate diastolic hypertension results in a decreased incidence of stroke and, to a lesser extent, a reduction in incidence of coronary heart disease [MacMahon SW, Cutler JA, Furberg CD, et al: Prog Cardiovasc Dis 1986; 29 (suppl 1): 99-118]. Even so, the decrease in overall mortality rate is not consistent. Although hypertension occurs with increasing frequency in those over 60 years of age, patients in this age group represent less than 12 percent of the subjects in large trials. Currently, stepped-care is the recommended approach for managing hypertension in patients of all ages. However, the availability of a variety of agents for initial therapy, all with approximately equal efficacy but differing side-effect profiles, calls such an approach into question.
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PMID:The evolution of current hypertension therapy. 304 93

Results of prospective cohort epidemiological studies in different population groups indicate a constant positive and graded association between the level of systolic blood pressure and subsequent mortality from cardiovascular diseases and stroke, especially with advancing age, and irrespective of the level of diastolic blood pressure. Thus, isolated systolic hypertension in the elderly, defined as systolic blood pressure greater than or equal to 160 mmHg and diastolic blood pressure less than 90 mmHg, is a powerful risk factor for mortality and morbidity. In the Hypertension Detection and Follow-Up Program (HDFP), the multiple logistic analysis of the impact of isolated systolic hypertension on 8-year mortality showed that, in the age group 60-69 years, after adjustment for other factors, there was about a 1% increase in mortality each year for every 1-mmHg increase in systolic blood pressure (P less than 0.05). Similarly, among those screened during the Multiple Risk Factor Intervention Trial (MRFIT), aged 55 years and above, the relative risk of stroke mortality in those with isolated systolic hypertension was 3.0, with a 95% confidence interval of 1.3 to 6.8. The United States National Health Survey data estimate the prevalence of isolated systolic hypertension as 8.5% in the age group 65-74 years. The prevalence of isolated systolic hypertension rises significantly with age (6%, 11% and 18%, respectively in the age groups 60-69, 70-79 and above 80 years). Although treatment of diastolic hypertension in the elderly has been shown to be effective in reducing mortality, no adequate prospective evaluation has yet been completed to determine the efficacy of drug treatment of isolated systolic hypertension. Thus, the question of the efficacy of treatment remains unanswered.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Isolated systolic hypertension in the elderly. 306 88

Hypertension is a pervasive public health problem with enormous economic as well as medical consequences. Progress in developing more effective, safer and more convenient medications has been remarkable. Similarly, progress in focusing public and professional attention on hypertension has led to earlier treatment and undoubtedly contributed significantly to reduced stroke and cardiovascular mortality rates. Challenges in the next decade will be to resolve residual uncertainties about the balance of benefits and risk of treatment in mild diastolic hypertension and isolated systolic hypertension, and to develop incentives for maximizing the cost-effectiveness of treatment in those for whom treatment is, on balance, beneficial. Quality-of-life parameters will play prominent roles in clinical and policy decisions with respect to each of these challenges.
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PMID:Economics in hypertension management: cost and quality trade-offs. 310 2

A long-term prognosis and outcome study of elderly hypertensives (aged 60 years or over) was made based on the 20-year prospective population survey conducted in a Japanese rural community (Hisayama) and the results were compared with those for younger subjects (aged 40-59 years). The risk of cardiovascular mortality related to blood pressure level increased with the elevation of either systolic or diastolic pressure in both younger and elderly groups. Cardiovascular mortality increased markedly at a systolic pressure of greater than or equal to 160 mmHg, or a diastolic pressure of greater than or equal to 100 mmHg for those aged 40-59 years. There was no cut-off level for increased risk of cardiovascular mortality for either systolic or diastolic pressures for those aged 60 years or over. Stroke mortality was seven times higher in systolic, and 10 times higher in diastolic hypertensives than in normotensives (P less than 0.01) for the group aged 40-59 years. However, deaths due to stroke and heart disease were more frequently associated with borderline (relative risk 2.3 and 2.3, respectively; P less than 0.01), systolic (relative risk 3.2 and 3.7, respectively; P less than 0.01) and diastolic hypertension (relative risk 2.1 and 4.8, respectively; P less than 0.01), compared to normotension for those aged 60 years or over. Intracerebral hemorrhage and cerebral infarction occurred more frequently in diastolic hypertensives for both young (relative risk 9.8 and 4.8, respectively; P less than 0.01) and elderly subjects (relative risk 3.4 and 1.5, respectively; P less than 0.01) than in normotensives.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prognosis and outcome of elderly hypertensives in a Japanese community: results from a long-term prospective study. 322 Oct 98

The large cohort of white men (317,871) 35 to 57 years old at initial screening for possible enrollment into the Multiple Risk Factor Intervention Trial (MRFIT) was examined with regard to initial blood pressure levels and subsequent coronary heart disease (CHD), stroke, and all-cause mortality. The overall prevalence of isolated systolic hypertension (ISH), defined as systolic blood pressure (SBP) greater than or equal to 160 mm Hg and diastolic blood pressure (DBP) less than 90 mm Hg, was 0.67% among white men screened for MRFIT and increased with age (0.31% among 35- to 39-year-olds to 1.7% among 55- to 57-year-olds). The 6 year CHD and all-cause mortality rates in men over 50 were highest in those with ISH compared with both subjects with diastolic hypertension and those with normal pressure. The relative risk of death from stroke in those with ISH, compared with that in those with SBP less than 160 mm Hg and those with DBP less than 90 mm Hg, was 3.0 (95% confidence interval 1.3 to 6.8). In addition, at any level of DBP, the level of SBP appeared to be the major determinant of all-cause and CHD mortality. The determinants of ISH in individuals under 60 years of age as well as the possible efficacy of its treatment should be evaluated further.
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PMID:Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial. 327 36

Static exercise is commonly encountered occupationally and in normal activities of daily living. In addition, weight training, a form of static exercise, is one of the fastest growing physical activities in the United States. Static exercise is a stressor to the cardiovascular system. At high intensities it produces immediate and profound systolic and diastolic hypertension, moderate tachycardia and enhanced contractility resulting in a moderate increase in cardiac output without an increase in stroke volume. Static exercise is well tolerated in healthy people. People with cardiovascular disease appear to tolerate static exercise of low intensity if they have normal left ventricular fraction and reserve. However, in people with impaired left ventricular function and reserve, the exercise stress causes tachycardia, a hypertensive state, increased systemic vascular resistance, and left ventricular end diastolic pressure. If the exercise stress persists, stroke volume and ejection fraction decline. This article helps nurse practitioners in wellness and preventive patient education. An analysis of current research covers the relationship between client variables and the cardiovascular effects of static exercise. Nurse practitioners learn how to identify and advise clients who should avoid static exercise. The proper selection of a health fitness club and the proper components of a basic weight-training program are comprehensively reviewed.
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PMID:Static exercise--physiologic dangers and proper training techniques. 328 11

The cardiovascular mortality experience of over 7000 Canadians ages 35-79 years free of self-reported heart disease or stroke who participated in the Nutrition Canada survey is presented. The effects of various risk factors on cardiovascular disease mortality were assessed using multivariate Poisson regression analyses. Factors associated with a significantly increased risk of dying included cigarette smoking, hypertension, diabetes and, for women, serum cholesterol. Relative risks were similar for those ages 35-64 years compared to those 65-79 years for diabetes but were higher among those 35-64 years for cigarette smoking, diastolic hypertension, obesity and serum cholesterol (females only). Individuals drinking three or more drinks daily had a relative risk of 3.18 for stroke. Population attributable risks for smoking, hypertension, elevated serum cholesterol and diabetes, respectively, were 47%, 21%, 7% and 8% for men and 10%, 21% 18% and 16% for women.
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PMID:Major risk factors for cardiovascular disease mortality in adults: results from the Nutrition Canada Survey cohort. 340 26

From March 1, 1979 thru September 30, 1984 we performed 56 cardiac transplants (Tx). The first 32 patients received conventional immunosuppression therapy consisting of azathioprine/prednisone (I/P), while the subsequent 24 patients received cyclosporine/prednisone (C/P). Twenty-one of 32 I/P patients ages 39 +/- 3 years (SEM), and 16 of 24 eligible C/P patients ages 36 +/- 3 years, survived one year with follow-up through September 30, 1985. The one year post-transplant course of these 37 patients was evaluated by chart review. While donor ages are similar, ischemic time was shorter in the conventionally treated patients. The initial hospital stay for I/P vs C/P was 67 +/- 6 vs 33 +/- 3 days (p less than .05), at a total cost of $49,900 +/- $5,800 vs $53,800 +/- $10,000. During the first year following transplantation, the I/P patients required an additional 34 +/- 7 days of hospitalization, while C/P patients required 16 +/- 10 days. Over the first year, the number of infections and rejections differed at 2.8 +/- 0.6 per I/P patient vs 1.2 +/- 0.3 per C/P patient, and 2.5 +/- 0.4 per patient vs 1.5 +/- 0.3 per patient respectively (p less than .05). Renal function test results were better in the I/P group. Results of cardiac catheterization performed at one year were similar except for cardiac index and stroke volume index, both being higher in the C/P group. Coronary anatomy was considered normal in all. These data indicate that while overall survival is similar, a shortened post-transplant hospital course with fewer necessary hospitalizations, rejection episodes and infection episodes characterizes the first year in survivors receiving C/P immunosuppression. While both groups had multiple hemo-dynamic abnormalities as compared to normal subjects, cardiac index and stroke volume index were improved in the C/P group. Therapy with C/P represents an advance in immunosuppression for cardiac transplantation as compared to I/P; however, decreased renal function and diastolic hypertension were problems in the C/P group.
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PMID:Cardiac transplant patient at one year. Cyclosporine vs conventional immunosuppression. 352 20

The incidence of hypertension in the geriatric population is very high and is a significant determinant of cardiovascular risk in this group. The tendency for blood pressure to increase with age in westernized societies such as the United States may depend on environmental factors such as diet, stress, and inactivity. Our population tends to become more obese; to consume relatively greater amounts of sodium and lesser amounts of potassium, calcium, and magnesium; and to decrease exercising with increasing age. Senescent changes in the cardiovascular system leading to decreased vascular compliance and decreased baroreceptor sensitivity contribute not only to rising blood pressure but also to an impairment of postural reflexes and orthostatic hypotension. The hallmark of hypertension in the elderly is increased vascular resistance. Greater vascular reactivity in the elderly hypertensive patients may reflect decreased membrane sodium pump activity and decreased beta-adrenergic receptor activity as well as age-related structural changes. Treatment of diastolic hypertension in the elderly is associated with decreased cardiovascular morbidity and mortality. Although treatment of systolic hypertension may not decrease immediate cardiovascular mortality, it appears to decrease the incidence of stroke. The initial therapeutic approach to the elderly hypertensive patient should generally consist of a reduction in salt and caloric intake and an increase in aerobic exercise, i.e., walking. Drug therapy should be initiated with lower doses of medication with a special concern about orthostatic hypotension.
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PMID:Hypertension in the elderly. 354 29

Central and forearm haemodynamics were studied in 73 middle-aged male subjects: 14 normotensive controls and 59 patients with sustained essential systolic/diastolic hypertension. Hypertensives were divided into two groups: pulse pressure within the normal range (40-60 mmHg; group I) or above 60 mmHg (group II) for the same level of mean arterial pressure (MAP). Indices of systemic and forearm arterial compliance and distensibility for the same age and MAP were reduced to the same extent in group I and II. In contrast, the peak systolic blood flow velocity of the brachial artery, cardiac output (CO) and stroke volume (SV) were significantly greater in group II than in group I. Systemic and forearm vascular resistances were significantly increased in group I but remained within the normal range in group II. The study provided evidence that, in middle age, there is a group of hypertensive patients characterized by a disproportionate increase in pulse pressure for the level of MAP. The elevation of the pulsed component of blood pressure (BP) reflects a relative hyperkinesia with an increase in CO and arteriolar vasodilatation. The subsequent increase in systolic pressure is produced by a combination of reduced arterial distensibility and increased SV.
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PMID:Pulse pressure in sustained essential hypertension: a haemodynamic study. 361 71


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