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Understanding the problem of hypertension in the elderly calls not only for an understanding of the physiologic phenomenon involved, but of the statistics currently available pertaining to this widespread disorder. In the age group 60 to 69 years, more than 25% of the population screened by the Hypertension Detection and Follow-Up Program (HDFP) had isolated systolic hypertension; ie, a systolic blood pressure greater than or equal to 140 mmHg with a diastolic blood pressure less than 90 mmHg. Setting the criterion for definition at a systolic blood pressure greater than or equal to 160 mmHg, the prevalence in this age group was almost 10%. Prevalence of diastolic hypertension, ie, diastolic blood pressure greater than or equal to 90 mmHg in this age group was more than 40%. Data from that same study show also that elevated systolic blood pressure in the face of a normal diastolic blood pressure was associated significantly with increased mortality. In the HDFP, stepped-care treatment reduced the five-year incidence of fatal and nonfatal stroke in these individuals by more than 50%. These results were achieved with minimum side effects. Reports of this kind surely will overcome the popular tendency to consider elevated blood pressure in the elderly as a natural phenomenon of aging and, hence, acceptable. There is nothing natural about hypertension in the elderly, nor should it be acceptable. Because it is important to control hypertension before it can cause end-organ damage, physicians are urged not to postpone treatment of hypertension in the elderly, but to initiate it promptly, keeping in mind the whole physiologic and psychosocial state of the elderly patient with hypertension.
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PMID:Prevalence and prognostic significance of hypertension in the elderly. 394 1

Twenty-five adolescents (aged 16 +/- 1 years) whose blood pressure (BP) was persistently above the 95th percentile for their age and sex were studied before and after 6 +/- 1 months of exercise training and again 9 +/- 1 months after the cessation of training. Maximal oxygen consumption (VO2) increased significantly with training. There was no change in body weight or sum of skinfolds. Both systolic and diastolic BP decreased significantly with training; however, complete BP normalization was not achieved. When the subjects were retested 9 +/- 1 months after cessation of training, systolic BP and VO2 max had returned to pretraining levels; however, diastolic BP was still below pretraining levels in the subjects who had diastolic hypertension initially. Except in subjects who initially had an elevated cardiac output, no consistent hemodynamic changes were found with training or cessation of training to account for the reductions in BP. The subjects whose resting cardiac outputs were high initially had significantly lower cardiac outputs after training as a result of decreases in both heart rate and stroke volume; however, vascular resistance remained unchanged. Sedentary control subjects with similar BP had no significant change in any of the variables measured over a similar period. These data indicate that moderate endurance exercise training can lower BP in otherwise healthy hypertensive adolescents as an initial therapeutic intervention.
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PMID:Effect of exercise training on the blood pressure and hemodynamic features of hypertensive adolescents. 662 69

The results of the physical analysis of circulation presented in this report are a further fragment of our research on the state of the circulatory system in the merchant marine officers over 40. 307 men were selected at random for the examinations, this constituting 13.5 per cent of the total population of the officers employed by the shipowner. Altogether the examinations covered 118 deck officers, 152 engine-room officers and 37 officers of the catering department. The parameters of the physical analysis of circulation were calculated according to Broemser-Ranke. The mean value of pulse wave velocity at the aorta was 833.63 +/- 155.41 cm/sec and in the radial artery--891.93 +/- 124.91 cm/sec for the whole examined population. The mean deformation resistance for all the examined was 1349.02 +/- 248.68 dyne/cm and the circumferential resistance--1347.55 +/- 347.89 sec. dyne/cm3. The mean systolic discharge for all the examined was 82.68 +/- 18.66 ml and the minute stroke volume 6.64 +/- 1.92 l/min. The mean work of the heart 1.20 +/- 0.38 J, the heart's power--1.60 +/- 0.59 W. The velocity of the discharge from the left ventricle was on average 17.66 +/- 3.44 l/min. For those parameters no statistically significant differences were found between particular groups of employment aboard. However, statistically significant differences were discovered in the calculations of the pulse wave velocity at the aorta. The differences were noticed between the group of clinically healthy men (771.52 +/- 114.71 cm/sec) on the one hand and the overweight group (854.39 +/- 116.34 cm/sec), the obese group (900.13 +/- 155.08 cm/sec), the group with ECG changes (925.01 +/- 193.24 cm/sec), the group with systolic and diastolic hypertension (acc to WHO criteria) (997.16 +/- 177.82 cm/sec), and in the group with hypertension accompanied by systolic discharge murmurs above the aorta (1113.38 +/- 127.24 cm/sec)--on the other. The pathological pulse wave velocity in the aorta (i.e. velocity of at least 9 m/sec) was found in 22.47% of the whole examined population.
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PMID:Evaluation of the state of the circulatory system in the officers of the Polish Ocean Lines. III. A physical analysis of circulation. 668 58

The participants in a community health survey in the Reykjavik area answered the question whether a first-degree relative had had myocardial infarction (MI), hypertension (HT) or cerebral stroke. The mean total serum cholesterol level was 5-10 mg/dl higher in the group with a positive history of MI than in the negative group. The frequency of hyperlipidaemia and the levels of other risk factors measured (blood pressure and body mass index) were similar in both groups. The group with a positive family history (FH) of HT had a mean systolic blood pressure 6-8 mmHg higher and diastolic hypertension (greater than 105 mmHg) on a single measurement twice as frequently as the negative group. The mean systolic blood pressure in the group with positive FH of stroke was 8-10 mmHg higher than in the negative group. The study thus suggests that positive FH of HT or stroke among first-degree relatives is a worthy indication for blood pressure measurements, at least after the age of 40.
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PMID:Screening for health risks. How useful is a questionnaire response showing positive family history of myocardial infarction, hypertension or cerebral stroke? 682 18

Basal hemodynamics and plasma catecholamines were measured in 10 patients with systolic hypertension, 7 males and 3 females, aged 38-69 years (Group 1), and in 10 patients with systolic and diastolic hypertension, 7 males and 3 females, aged 40-65 years (Group 2); the same measurements were repeated after acute pharmacological alpha and beta-blockade with Labetalol, 100 mg iv, or Propranolol, 10 mg iv, plus Phentolamine, 10 mg iv. In patients of Group 1 plasma noradrenaline was inversely related to systolic arterial pressure and to stroke index and was directly related to heart rate. In patients of Group 2 plasma noradrenaline was directly related to systolic arterial pressure. After acute alpha and beta-blockade the degree of reduction of systolic arterial pressure was directly related to basal plasma noradrenaline in both groups; systolic arterial pressure was reduced to normotensive levels in 5 patients of Group 1 who had high basal plasma noradrenaline values. These results confirm some of our previous findings and suggest that in some patients with systolic hypertension adrenergic activity is increased and may have a significant role in maintaining high blood pressure values.
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PMID:Adrenergic activity in systolic hypertension. 711 59

MONICA Project findings provide a unique opportunity to compare cardiovascular disease (CVD) risk factor levels in a large number of populations living in different political systems. 15 European communist populations had significantly higher age-standardized mortality for age groups 35-64 years from all causes, from CVD and stroke than 25 democratic MONICA populations. The prevalence of systolic and diastolic hypertension in males and females, prevalence of smoking in males and prevalence of overweight in females were significantly higher in communist MONICA populations. In these populations there was tendency to lower prevalence of hypercholesterolemia. In simple and multiple regression analysis hypertension and smoking prevalence had the highest relation with CVD mortality in men; hypertension and overweight prevalence had the highest relation with CVD mortality in women. The combination of 'classical' CVD risk factors could explain only part of differences observed. In communist Europe there was high consumption of spirits, low consumption of fruits and extremely low intake of citrus fruits. Instead of exaggerated anti-cholesterol propaganda emphasis should be given to the prevention of antioxidant deficiencies by the increase of fruit and vegetable consumption and to the decrease in salt, spirit and cigarette consumption in former communist countries.
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PMID:Cardiovascular risk factors in the former communist countries. Analysis of 40 European MONICA populations. 767 76

Direct evidence about the effects of antihypertensive treatment on vascular disease in older patients is available from five randomized trials conducted exclusively in patients over the age of 60 years. These trials involved a total of 12,483 individuals with systolic or diastolic hypertension (mean age = 72 years, mean entry blood pressure = 181/88 mmHg). Over an average follow-up period of 4.7 years, a 15/6 mmHg difference in blood pressure between study and control groups was achieved. Among those patients assigned active treatment, stroke incidence was reduced by 34% SD6 and coronary heart disease incidence was reduced by 19% SD7. These proportional reductions were of similar size to those observed in trials in predominantly younger patients. However, the absolute benefits observed in older patients were more than twice as great as those observed in younger patients. The results suggest that over 10 years, treatment would prevent at least one major vascular event among every 10 elderly patients at similar risk to those enrolled in the trials.
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PMID:The effects of blood pressure reduction in older patients: an overview of five randomized controlled trials in elderly hypertensives. 826 1

Several imperatives drive the need to establish the merit of treating isolated systolic hypertension in the elderly. These include its higher prevalence with age, the associated excess cardiovascular risks, and the rapid aging of the population. The Systolic Hypertension in the Elderly Program demonstrated a significant reduction in stroke incidence (fatal and nonfatal) (36%, equivalent to preventing 30 strokes per 1,000 participants per 5 years). A 27% reduction in coronary heart disease incidence and a 32% reduction in all major cardiovascular events were also achieved (equivalent to the prevention of 16 and 55 events per 1,000 participants per 5 years, respectively). These results were associated with a treatment regimen in which the primary agent was low-dose chlorthalidone. The benefits accrued to all subgroups identified based on baseline age, race and sex, blood pressure, serum cholesterol levels, and electrocardiographic abnormalities. The reduction in coronary disease is consistent with predictions based on prospective epidemiological studies and is concordant with other recent intervention trials. It is a reasonable inference from the Systolic Hypertension in the Elderly Program findings that middle-aged as well as older people with isolated systolic hypertension, and people with less severe degrees of this condition, particularly when other risk factors are present, would benefit from such therapy. Another reasonable implication of the trial relates to the matter of preferred drug treatment regimens for diastolic hypertension, in middle-aged as well as older people.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Implications of the systolic hypertension in the elderly program. The Systolic Hypertension in the Elderly Program Cooperative Research Group. 830 38

It has been hypothesized that as large arteries become more rigid with age, the pattern of hypertension changes from diastolic to systolic. Thus, diastolic blood pressure (DBP) may lose its ability to reflect the increase in vascular resistance with age. To assess this, we studied the age-related changes in blood pressure pattern and its steady-state and pulsatile determinants. We performed an epidemiological analysis based on a national survey of 10,462 subjects from Argentina. A hemodynamic analysis (impedance cardiography) was then carried out in 636 consecutive hypertensive patients (age, 25 to 74 years). Whereas the rate of increment in the prevalence of mild to moderate hypertension (MMH) reached a plateau after the sixth decade, isolated and borderline systolic forms of hypertension began a steep and sustained rise. Among patients with MMH, DBP remained stable from the third to the seventh decade, whereas SBP maintained a sustained increase. Despite similar DBP, the systemic vascular resistance index increased 47% (P<.01) and the cardiac index decreased 27% (P<.01), whereas the ratio of stroke volume to pulse pressure, an index of arterial compliance, decreased 45% (P<.01). However, there were no significant differences between older patients with MMH and those with isolated systolic hypertension in the level of SBP, vascular resistance, stroke volume, and cardiac index. Compared with age-matched normotensive control subjects, the ratio of stroke volume to pulse pressure was much more reduced in isolated systolic hypertension (48%) than in MMH (30%). In summary, the present study, carried out in a large sample of hypertensive subjects with a wide age range, showed a simultaneous impairment in vascular resistance and arterial compliance associated with aging in different patterns of hypertension. The magnitude of these changes, with opposite effects on DBP but additive effects on SBP, suggests that a hemodynamic mechanism could determine the transition in the prevalence of diastolic hypertension toward a systolic pattern of hypertension with aging. Also, the results suggest that SBP, but not DBP, is a reliable indicator of the underlying hemodynamic abnormalities (high resistance and low arterial compliance) in the elderly.
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PMID:Diastolic pressure underestimates age-related hemodynamic impairment. 933 77

From the follow-up examination of 1329 out of 4420 type 2 (non-insulin-dependent) diabetes followed for 17 years, the incidence of micro and macrovascular complications (proteinuria and nephropathy, symptoms of leg vascular disease, ischemic heart disease, and cerebrovascular events, was estimated and related to the levels of baseline-risk variables using logistic regression. For new cases of proteinuria and heavy proteinuria, hyperglycemia was the common predictor (alongside diastolic hypertension, smoking and overweight); hyperglycemia and glycosuria were among significant predictors of leg vascular disease (with duration of diabetes, smoking, male sex, diastolic hypertension, and proteinuria). On the other hand, systolic hypertension and male sex prevailed among factors predicting both ischemic heart disease (with high cholesterol and overweight), and stroke. The data confirm the higher involvement of diabetic milieu in micro than macrovascular incidents, with diabetic foot disease placed in between.
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PMID:[Risk factors of the incidence of late vascular complications of diabetes]. 1033 28


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