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

Hypertension increases in prevalence with advancing age and is a leading cause of morbidity and mortality from cardiovascular disease. Patients with hypertension are at increased risk for the development of myocardial infarction, stroke, and congestive heart failure compared with their normotensive counterparts. Early hypertension intervention trials in patients with diastolic hypertension documented the benefits of blood pressure control in reducing the risk for cardiovascular disease events. In recent years, several trials have demonstrated the benefits of treating older patients with isolated systolic hypertension. Consequently, hypertension guidelines have evolved to reflect the important role of systolic blood pressure in determining hypertension status and have devoted much attention to isolated systolic hypertension as a distinct blood pressure category. These data have important implications for the elderly, in whom isolated systolic hypertension is the most common form of high blood pressure; in addition, the absolute risk of cardiovascular disease is higher in older than in younger persons. Since the number of older persons in developed countries is increasing, hypertension has become a growing public health concern.
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PMID:The role of systolic blood pressure in determining risk for cardiovascular disease. 1034 Aug 39

Hypertension is the most important risk factor in the development of stroke. It is also the risk factor most amenable to treatment. The results from 18 controlled trials show a reduction in relative risk of stroke of 25-47% among treated hypertensive patients. This reduction applies both to the elderly and to younger patients, but the absolute reductions are greater among the elderly and the number of patients with hypertension that need to be treated to prevent a stroke is lower in the elderly because they have a higher risk of stroke. The reductions in relative but not absolute risk appear to be similar for both isolated systolic hypertension and combined systolic and diastolic hypertension in the elderly. The case for antihypertensive treatment in the secondary prevention of stroke is less clear but the results of four clinical trials of antihypertensive treatment among patients with and without hypertension and a history of cerebrovascular disease point to a probable benefit. The results of the PROGRESS trial will elucidate this further.
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PMID:Blood pressure lowering for the primary and secondary prevention of stroke: treatment of hypertension reduces the risk of stroke. 1050 Dec 69

A high burden of hypertension-related cardiovascular disease remains an unfortunate hallmark in the southeastern United States (also known as the Stroke Belt). A convergence of factors related to aging, systolic blood pressure (BP), and hypertension control rates indicate that the Southeast burden will remain and probably increase well into the next century unless strategic initiatives are undertaken soon. More specifically, systolic BP, which is a major independent risk factor, increases as a function of age, whereas diastolic BP reaches a plateau. Given a selective immigration of elderly residents from other areas of the country, the Southeast is "aging" more rapidly. Thus, isolated systolic hypertension (ISH), which carries a very high relative risk, is likely to increase at a faster rate in the Southeast than in other areas of the U.S. Moreover, control rates for systolic BP are poorer than for diastolic BP. Hypertension control rates are also lower in elderly people than in younger patients with hypertension. In the absence of a paradigm shift in medical practice, control rates will decline as the prevalence of ISH rises in an aging population. The health and economic implications of an inadequate response to this challenge are imposing, particularly for the Southeast. On a positive note, the emerging recognition of systolic BP as a significant risk factor may lead to more appropriate recognition and higher rates of treatment and control. Randomized, controlled clinical trials have clearly established that treatment reduces BP in the elderly patient with ISH and combined systolic-diastolic hypertension. Moreover, treatment dramatically reduces hypertension-related cardiovascular complications among elderly patients with hypertension. In summary, the Southeast will lead the aging of the nation into the next century. The implications of this large demographic shift are likely to worsen rather than reduce the relative burden of cardiovascular disease in the Stroke Belt. Thus, a high priority should be given to the recognition, treatment, and control of systolic hypertension in the Southeast.
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PMID:The dominant role of systolic hypertension as a vascular risk factor: evidence from the southeastern United States. 1061 60

Isolated systolic hypertension and combined systolic and diastolic hypertension are clinical problems affecting significant numbers of older adults (>65 years). Preventing the complications of hypertension, including stroke and coronary artery disease, may potentially impact not only an individual's sense of well-being, but also their functional status and ability to live independently in the community. Despite the increased absolute risk for cardiovascular events associated with hypertension in older adults compared with younger adults, significant numbers of individuals remain untreated or inadequately treated. There is clinical data to show that treating both isolated systolic hypertension and combined systolic and diastolic hypertension results in a significant reduction in cardiovascular events in older adults. Although there is a growing body of literature on treatment of hypertension in the 60- to 80-year-old, the data on individuals greater than 80 years old is lacking. The challenge becomes to treat hypertension safely in the presence of multiple medications and other diseases.
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PMID:Hypertension in older adults. 1067 15

Our objective was to evaluate pretreatment predictors of longevity, particularly blood pressure, in a large cohort of hypertensive men. During 1974 to 1976, 10,367 male hypertensive veterans (47% black) were identified at screening and subsequently characterized in 32 special Veterans Administration (VA) hypertension clinics. Their mean age was 52 years and mean blood pressure (BP) 154/100 mm Hg. During an average of 21 years of follow-up, 61% died. Risk ratios for all-cause mortality as functions of BP and other risk factors are presented for each variable alone; for each variable controlling for age, race, and BP; and for a multivariate model. We observed that when the entire cohort was divided into deciles by systolic blood pressure (SBP) and by diastolic blood pressure (DBP), the risk ratios for 21-year mortality increased from lowest to highest decile by 178% for SBP and 16% for DBP. When the deciles were computed separately by age group, increases from lowest to highest decile for those less than 40 years of age were 138% for SBP and 263% for DBP. For those over 60 years, the increases were 154% and -10%, respectively. Although blacks were younger and had more severe diastolic hypertension than whites, the risk ratios were similar within each race group. Risk patterns for mean arterial pressure and pulse pressure resembled those for SBP but had smaller gradients. Survival curves for BP groups suggested constant mortality rates during follow-up. Other significant observations included decreasing mortality with increasing body mass index and increased mortality in the Stroke Belt. We concluded that pretreatment SBP strongly predicted all-cause mortality during 21-year follow-up. For the young, both SBP and DBP were strong predictors; for the elderly, only SBP was predictive.
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PMID:Pretreatment blood pressure as a predictor of 21-year mortality. 1091 62

The first effective antihypertensive treatment became available in the 1950s but the early drugs caused intolerable side effects. Drugs with a better side-effect profile became available in the 1960s, and their utility was soon subjected to rigorous clinical trials. In the 1970s, the availability of these drugs opened the door for outcome studies. Most of the results reported in the 1970s and 1980s were rather impressive. Antihypertensive treatment reduced mortality in severe and mild hypertension, in hypertension of the elderly, and in patients with advanced complications of hypertension. A large number of 'hard end point' (mortality and morbidity) trials were organized in the last decade of the 20th century. Most compare the merits of new antihypertensive agents (angiotensin-converting enzyme inhibitor, calcium channel blocker, angiotensin II receptor blocker) versus an older (beta-blocker or diuretic) drug. These trials are rooted in the fact that blood pressure lowering does not equally affect all complications of hypertension. Particularly bothersome is the fact that treatment decreases stroke but fails to substantially reduce coronary events. These variations in treatment outcomes may reflect the multifactorial pathophysiology of hypertension: essential hypertension is frequently associated with pressure-independent coronary risk factors, and the target organ status of a patient (left ventricular hypertrophy, renal dysfunction) greatly affects their prognosis. These new trials investigate whether the mechanism by which a drug decreases the pressure and how it affects various risk factors are of clinical relevance. The practice of medicine in hypertension is evidence bound. Historically, only when the superiority of the treatment had been convincingly shown did physicians alter practice patterns. The effects of systolic blood pressure lowering and of treating mild diastolic hypertension in younger patients have not been sufficiently investigated. Lowering of the systolic blood pressure and treating patients with mild hypertension might have major beneficial effects on public health. We need new studies in this area in order to improve clinical practice in hypertension.
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PMID:Five decades of antihypertensive treatment: the unresolved issues. 1095 81

Cardiovascular disease is still the most common cause of morbidity and mortality in the elderly and hypertension is a significant risk factor for CVD such as stroke, myocardial infarction, and chronic renal disease. Fortunately, hypertension is readily treatable. A clear benefit from treating elevated blood pressure has been demonstrated by several clinical trials. In fact, benefit from treatment of either systolic or diastolic hypertension in this group is much greater than in younger hypertensives. Understanding physiologic and socioeconomic changes with age is an essential part of treatment and will allow for individualized treatment suitable for the elderly. Life-syle modification is a good starting point to control high blood pressure but should not be enforced unrealistically in this group. Once pharmacologic therapy is decided upon it should be started with a lower dose than usual and should be slowly titrated. Monotherapies and combination therapies are available for treatment of hypertension. All clinicians who take care of the geriatric population should be aware of the benefit of antihypertensive therapy since this is one of the most rewarding aspects of preventive medicine.
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PMID:Hypertension In The Elderly. 1141 14

Smoking, hypertension, and hyperlipidemia are the three most important modifiable risk factors contributing to the development of cardiovascular disease in older adults. Although the magnitude of risk associated with smoking and hyperlipidemia declines with age, the absolute number of cases attributable to these risk factors increases due to the increasing prevalence of cardiovascular disease. Smoking increases the risk of both coronary events and stroke in the elderly, and there is evidence that smoking cessation is associated with a rapid reduction in risk. Therefore, an aggressive effort to promote smoking cessation is strongly recommended in patients of all ages. Systolic and diastolic hypertension are powerful risk factors for cardiovascular disease in the elderly. Moreover, multiple clinical trials have demonstrated that blood pressure reduction reduces the risk of stroke, coronary events, heart failure, and cardiovascular death in individuals at least up to the age of 90. Accordingly, treatment of both systolic and diastolic hypertension are strongly recommended regardless of patient age. The importance of total serum cholesterol as a coronary risk factor declines with age, but the ratio of low density lipoprotein cholesterol (LDL-C) to high density lipoprotein cholesterol (HDL-C) remains an independent predictor of coronary events in older men and women. In addition, clinical trials have shown that cholesterol reduction is associated with improved clinical outcomes in individuals at or above 75 years of age. At the present time, the value of treating hyperlipidemia in patients greater than 80 years of age is unknown, and therapy in this age group must be individualized. (c)1999 by CVRR, Inc.
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PMID:Aggressive Risk Factor Management in the Elderly: Are You Ever Too Old? 1141 93

The Genetics of Hypertension Associated Treatment (GenHAT) study will determine whether variants in hypertension susceptibility genes interact with antihypertensive medication to modify coronary heart disease (CHD) risk in hypertensives. GenHAT is an ancillary study of the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial, ALLHAT, a double-blind, randomized trial of 42 418 hypertensives, 55 years of age or older, with systolic or diastolic hypertension and one or more risk factors for cardiovascular disease. About 50% are non-white, and about half are female. ALLHAT completes follow-up in March 2002. GenHAT is typing variants in hypertension genes; completion of genotyping is scheduled for 2003. Analysis of gene-treatment interactions in relation to outcomes include CHD, stroke, heart failure, and blood pressure lowering. To our knowledge, GenHAT is the largest pharmacogenetic study ever conducted. An added strength is its ability to link gene-treatment interactions with important clinical outcomes across diverse ethnic and gender groups.
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PMID:Pharmacogenetic approaches to hypertension therapy: design and rationale for the Genetics of Hypertension Associated Treatment (GenHAT) study. 1243 37

This review examines the pathophysiology of isolated systolic hypertension, changing medical perspectives on this condition as a cardiovascular risk factor in the community and evolving evidence of it being an independent risk factor for perioperative morbidity and mortality. Hypertension is regarded as an added risk in anaesthesia. Continuation of antihypertensive medication through the perioperative period is an established principle. Studies supporting this practice have demonstrated greater perioperative haemodynamic stability in association with general anaesthesia and surgery in patients with treated hypertension compared to untreated hypertension. Therapy has historically focused on control of diastolic blood pressure, rather than systolic blood pressure. Recent clinical trial data and data from large observational studies show a closer association of systolic hypertension with both coronary heart disease and stroke compared with diastolic hypertension. This has led to recommendations for aggressive treatment of isolated systolic hypertension, especially in patients over 65 years old. The association between decreased compliance of the central systemic arteries and isolated systolic hypertension is well understood. The fact that this same pathology, lack of compliance of central arteries, can cause a decrease in diastolic blood pressure is not so well recognised. This means that, in patients with isolated systolic hypertension, decreasing diastolic blood pressure can be associated with worsening arterial disease and that systolic minus diastolic blood pressure may give a better indication of the problem. Anaesthetic assessment and technique should be studied and potentially revised in the light of these changes in perspective on isolated systolic hypertension.
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PMID:Anaesthesia and isolated systolic hypertension--pathophysiology and anaesthesia risk. 1567 24


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