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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Elevated pulse pressure is an important cardiovascular risk factor in the elderly, and it remains to be determined whether this can be reversed. Drug treatment is justified in older patients with isolated systolic hypertension whose systolic blood pressure is 160 mmHg or higher on repeated measurement. Absolute benefit is greater in men, in patients aged 70 years or more, and in those with previous cardiovascular complications or greater pulse pressure. In the recently published comparative trials blood pressure gradients largely accounted for most, if not all, of the differences in outcome. In hypertensive patients, calcium-channel blockers may offer greater protection against stroke than against myocardial infarction, resulting in an overall cardiovascular benefit similar to that provided by older drug classes. The hypothesis that angiotensin-converting enzyme inhibitors or alpha-blockers might influence outcome over and beyond that expected on the basis of their blood pressure lowering effects still remains to be proved.
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PMID:Antihypertensive drug therapy in older patients. 1122 3

Left ventricular hypertrophy is an independent cardiovascular risk factor. In hypertensives, the pattern of hypertrophy is influenced by central haemodynamic characteristics. Central haemodynamics may also determine physiological differences in left ventricular structure and predispose to particular responses of the left ventricle to pathological increases in load. M-mode echocardiography was used to measure left ventricular diastolic dimension and to estimate left ventricular mass index, relative wall thickness and stroke volume in 159 healthy volunteers aged between 19 and 74 years. Tonometric sphygmography was used to estimate augmentation index, central end-systolic and mean arterial blood pressure. Effective arterial elastance was calculated as the ratio of end-systolic pressure to stroke volume. Left ventricular mass index and relative wall thickness were adjusted for variation in age, sex and blood pressure before analyses. Left ventricular diastolic dimension exhibited significant inverse correlations with both effective arterial elastance (r=-0.72, P<0.0001) and augmentation index (r=-0.23, P=0.004). Adjusted left ventricular mass index was inversely correlated with effective arterial elastance (r=-0.35, P<0.0001), but no correlation was observed between left ventricular mass index and augmentation index (r=0.04). Adjusted relative wall thickness correlated with increasing effective arterial elastance (r=0.32, P<0.0001) and augmentation index (r=0.18, P=0.02). Relative wall thickness (r=0.34, P<0.0001), but not left ventricular mass index, correlated with age. Higher elastance and augmentation correlates with relatively smaller left ventricular cavity size but larger relative wall thickness. Age-related changes in left ventricular afterload may affect relative wall thickness more significantly than left ventricular mass index and may contribute to a particular change in left ventricular geometry with age.
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PMID:Physiological relationships between central vascular haemodynamics and left ventricular structure. 1141 Jan 18

Epidemiologic and clinical studies have shown that increased pulse pressure is an independent cardiovascular risk factor in general population. Pulse pressure is determined by combined effects of cardiac factors (stroke volume) and the arterial stiffness. Arterial stiffness can be more directly evaluated by several measurements including the measure of pulse wave velocity (PWV). Aortic PWV, a marker of aortic stiffness, has been shown to be a strong independent predictor of cardiovascular and all cause mortality in patients with end-stage renal disease (ESRD) on hemodialysis as well as in patients with essential hypertension and older subjects over 80 years. Local arterial stiffness assessment, namely carotid distensibility was also shown to predict cardiovascular risk, both in ESRD patients and in renal transplant recipients. Furthermore, it has been shown in a therapeutic trial that the lack of aortic PWV attenuation despite significant drug-induced reduction in mean blood pressure was a significant predictor of cardiovascular death in subjects with ESRD. These results support the hypothesis that measurement of aortic PWV could then help, not only in risk assessment strategies, but also in risk reduction strategies by monitoring arterial stiffness under different pharmacologic regimens. The drug-related reduction of aortic PWV could then give prognostic information, additionally to blood pressure reduction. Aortic stiffness measurements could serve as an important tool in identifying ESRD patients at higher risk of cardiovascular disease. The ability to identify these patients would lead to better risk stratification and earlier and more cost-effective preventive therapy.
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PMID:Prognostic application of arterial stiffness: task forces. 1216 Feb 1

Coronary heart disease is a leading cause of death in industrialized nations. Hyperlipidemia with elevated serum total cholesterol, LDL cholesterol, and triglycerides is a known major cardiovascular risk factor. HDL cholesterol is considered to be protective, so low HDL cholesterol is being recognized as an independent cardiovascular risk factor that contributes to the development of atherosclerosis and related adverse cardiovascular events. The recognition of insulin resistance and metabolic syndrome is a step further in understanding these risk factors. Attempts at reducing serum cholesterol with different strategies in the past have met with limited success until the development of statins. The advent of statins has revolutionized the management of hyperlipidemia. The post-statins era has seen major clinical trials demonstrating the benefit of cholesterol reduction in the setting of both primary and secondary prevention. In general, there appears to be a 25% to 40% relative risk reduction in major adverse cardiovascular events such as death, myocardial infarction, and stroke. The recent megatrials further suggest that aggressive management of cholesterol in patients with high cardiovascular risk may be beneficial. Though the concept of the-lower-the-better may be looming, the question of "How low is good enough?" remains controversial. The results of recent megatrials such as the Heart Protection Study go a step further than the NCEP guidelines and suggest that statin therapy may benefit patients at high risk of cardiovascular disease regardless of their baseline values. We summarize the results of the available large clinical trials in our understanding of the management of dyslipidemia in a setting of primary prevention.
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PMID:Management of dyslipidemia in the primary prevention of coronary heart disease. 1235 27

OBJECTIVE To investigate the degree and potential cardiovascular determinants of arterial stiffness, assessed by aortic pulse wave velocity (PWV) measurements, and to relate arterial stiffness to absolute 10-12-year risks of stroke, coronary heart disease and death, as estimated by available risk functions, in postmenopausal women. METHOD We performed a cross-sectional study among 385 postmenopausal women, aged 50-74 years, sampled from the general population. Arterial stiffness was assessed non-invasively by measurement of aortic PWV using applanation tonometry. Information on health was obtained by medical history, registration of current medication, and physical examination. Height, weight, waist and hip circumferences, fasting glucose, total and high-density lipoprotein (HDL) cholesterol, triglycerides, resting blood pressure, and heart rate were measured. Three risk scores were used to estimate, for each individual, the absolute risk of stroke, coronary heart disease, and death within 10-12 years as a function of their cardiovascular risk factor profile. The relationship between PWV and these risk scores was subsequently determined. RESULTS Significant positive relationships with PWV were found for body mass index, fasting glucose, diabetes mellitus, and triglycerides in analyses adjusted for age, mean arterial blood pressure, and heart rate. Height and HDL cholesterol were inversely related to PWV. The risks of stroke, coronary heart disease, and death increased with increasing PWV in a linear graded manner. CONCLUSIONS This cross-sectional study among postmenopausal women provides evidence that most of the established cardiovascular risk factors are determinants of aortic PWV. Increased PWV marks an increased risk of stroke, coronary heart disease, and death within 10-12 years.
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PMID:Arterial stiffness in postmenopausal women: determinants of pulse wave velocity. 1240 54

Hypertension is the most widely treated cardiovascular risk factor, and there is clear evidence of the efficacy of treating systolic and diastolic blood pressure with existing antihypertensive agents in reducing stroke and cardiac disease. However, only about 25% of the US population has blood pressure controlled to at least 140 mm Hg systolic and 90 mm Hg diastolic. Hypertension control is a complex function of patient and physician behavior. Although poor hypertension control has historically been attributed to lack of health insurance or low utilization of available services, recently published analyses of national survey data and local physician and community samples suggest that physicians have a permissive attitude toward isolated mild systolic blood pressure elevations in the range of 140 to 160 mm Hg. The great majority of participants in health surveys report seeing a physician at least two times per year, and several investigators have documented that physicians are unlikely to increase treatment intensity for systolic elevations alone. Physician inaction toward elevated systolic blood pressure may be due to a reluctance to prescribe multiple drugs and/or lack of belief in the benefits of aggressive treatment to lower systolic blood pressure below 140 mm Hg.
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PMID:Uncontrolled hypertension as a risk for coronary artery disease: patient characteristics and the role of physician intervention. 1257 99

To investigate the impact of treatment on cardiovascular mortality and morbidity, we assessed outcomes in patients with hypertension and diabetes who received co-amilozide or nifedipine in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension. Participants had to be 55 to 80 years of age, with hypertension (> or =150/95 or > or =160 mm Hg) and at least one additional cardiovascular risk factor. Patients received 30 mg nifedipine once daily or co-amilozide (25 mg hydrochlorothiazide and 2.5 mg amiloride) daily. Doses were doubled if target blood pressures (<140/90 mm Hg) were not achieved. Primary (composite of cardiovascular death, myocardial infarction, heart failure, and stroke) and secondary outcomes (composite of primary outcomes, including all-cause mortality and death from vascular and nonvascular causes) were assessed by means of intent-to-treat analyses. There was no significant difference in the incidence of primary outcomes between nifedipine-treated and co-amilozide-treated patients with diabetes at baseline (n=1302) (8.3% versus 8.4%; relative risk, 0.99, 95% CI, 0.69 to 1.42; P=1.00). A significant benefit for nifedipine-treated patients was seen for the composite secondary outcome (14.2% versus 18.7%; relative risk, 0.76, 95% CI, 0.59 to 0.97; P=0.03). Among patients without diabetes at baseline (n=5019), there was a significant difference in the incidence of new diabetes (nifedipine 4.3% versus co-amilozide 5.6%, P=0.023). Nifedipine GITS once daily is as effective as diuretic therapy in reducing cardiovascular complications in hypertensive diabetics. Nifedipine-treated patients were also less likely to have diabetes or have secondary events (a composite of all-cause mortality, death from a vascular cause, and death from a nonvascular cause) than co-amilozide recipients. Our results suggest that nifedipine could be considered as first-line therapy for hypertensive diabetics.
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PMID:Outcomes with nifedipine GITS or Co-amilozide in hypertensive diabetics and nondiabetics in Intervention as a Goal in Hypertension (INSIGHT). 1292 58

Ramipril is safe and effective in the treatment of hypertension and heart failure, but this is not reviewed here. Ramipril is a lipophilic angiotensin-converting enzyme inhibitor suitable for once-daily administration. In addition to decreasing angiotensin II and increasing bradykinin levels, ramipril increases the levels of vasodilatory renal medullary neutral lipids and inhibits platelet-derived growth factor-induced proliferation of glomerulus cells. Ramipril also decreases transforming growth factor-beta in the kidney. Changes in kidney structure and proteinuria are characteristics of the streptozotocin (STZ) rat model of diabetes, and these are prevented by ramipril. In STZ diabetes, doses of ramipril that have no effect on blood pressure reverse vascular hypertrophy. In animal models of kidney failure (subtotal nephrectomy, stroke-prone spontaneously hypertensive rats), ramipril is renoprotective and some of this renoprotective effect is independent of blood pressure lowering. In humans, clinical doses of ramipril probably do not modify glucose metabolism but do reduce the levels of LDL- and HDL-cholesterol. In clinical trials of renal effects, ramipril has been shown to increase cortical nephron flow in hypertension and to reduce proteinuria in patients with and without diabetes and/or hypertension. Some of the smaller clinical trials showed beneficial effects on kidney function with low doses of ramipril that do not lower blood pressure. A large clinical trial in nondiabetic proteinuria, the Ramipril Efficacy in Nephropathy (REIN) trial, has shown that ramipril 1.25 mg/day, which does not lower blood pressure, arrested the decline in glomerular filtration rate and prolonged the time to end-stage renal failure. In diabetic patients who have had a previous cardiovascular event or having one other cardiovascular risk factor, the MICRO-HOPE clinical trial showed that ramipril lowers the combined risk of myocardial infarction, stroke and cardiovascular death by 25%. In conclusion, ramipril has proven beneficial effects in kidney disease alone or in association with diabetes and in diabetes without kidney disease, and is the pril for diabetes and kidney disease. (c) 2001 Prous Science. All rights reserved.
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PMID:Is Ramipril the pril for diabetes and kidney disease? 1276 20

Hypertension and its related comorbidities continue to drain South Carolina of approximately $9 billion dollars a year in direct medical costs and indirectly through lost productivity. Improving control rates of blood pressure and associated cardiovascular risk factors in the primary care physician's office is a fundamental and crucial step to decrease the very high incidence of stroke and cardiorenal diseases. By monitoring prescribing patterns through the Initiatives' data feedback program, providing evidence-based management approaches through educational seminars, and by applying improved treatment protocols, physicians can have a profound impact on outcomes. The growing collaborative partnership spawned by the Hypertension Initiative now includes primary care providers, Hypertension Specialists in the local community, and the ASH Carolinas-Georgia Chapter. The growth and impact of the partnership is facilitated by a dynamic data auditing and feedback program that provides the basis for constructive change focused on optimizing cardiovascular risk factor control in patients across the State. By continuing to make progress in addressing the control of blood pressure and associated cardiovascular risk factors through a growing collaborative partnership with primary care providers statewide, South Carolina can move from worst to first in cardiovascular health. In the future, we hope to add a dynamic health promotion program to active disease management efforts. In the process, South Carolina can move from a leader in cardiovascular disease to a model of cardiovascular health.
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PMID:2003 update on the Hypertension Initiative of South Carolina. Bringing South Carolina from "worst to first" in cardiovascular health. 1288 1

This study documented findings on the relation between cognitive functioning (perceptual speed, memory, fluency, and knowledge) and cardiovascular and metabolic disease in a sample of very old adults (ages 70 and older), both cross-sectionally (n=516) and longitudinally (n=206) in a 4-year follow-up. After age, SES, sex, and dementia status were controlled for, 4 diagnoses were negatively associated with cognition: congestive heart failure, stroke, coronary heart disease, and diabetes mellitus, with a joint effect of 0.47 standard deviations. The impact of disease status was largest on perceptual speed and fluency, memory was impacted only by diabetes, and knowledge was not related to any somatic diagnosis. There was no differential decline in participants diagnosed with 1 of these 4 diseases and those who were not. The only cardiovascular risk factor associated with cognitive performance was alcohol consumption.
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PMID:Relation between cardiovascular and metabolic disease and cognition in very old age: cross-sectional and longitudinal findings from the berlin aging study. 1464 Aug 52


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