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Query: UMLS:C0085580 (essential hypertension)
 14,686 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Nowadays treatment of risk factors seem to be most successful than treating illness itself or its complications. The importance of prospective international surveys in reducing complications has been underlined. From an epidemiological point of view, therapeutic strategies have proved to be more eficacious when applied to the whole hypertensive population than to selective high risk groups. Historically, tendency was aimed to lower diastolic blood pressure, classically a marker of essential hypertension. At present, trends seem to indicate that prognosis is more influenced by systolic hypertension, mainly in the aged. As aging progresses, diastolic pressure tends to decrease, arteries become rigid, cardiac output diminished and pulse wave velocity increases enhancing quick blood return to the heart at the end of systole. All these changes heighten blood pressure, overload the heart and diminish coronary flow. It has been recently reported that lowering diastolic blood pressure under 85-80 mmHg leads to coronary insufficiency or death. HOT study is under way in order to achieve the right criteria on this point. In our view, a key figure is not going to be the answer for everyone.
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PMID:[Treatment for prevention of complications. The case of hypertension]. 865 52

This review describes the most recent advances in the treatment of essential hypertension, from non pharmacological measures and changes in lifestyles to new blood pressure lowering drugs. A blood pressure lower tha 130/80 mmHg, has been established as the new goal for optimal treatment. In the last two consensus a new range of blood pressure, denominated "high normal" (130-139/85-89 mm Hg) has been incorporated. People with other cardiovascular risk factors and a blood pressure within this range, should be treated. The HOT study recently demonstrated that a reduction to less than 90 mmHg of diastolic pressure is associated with a reduction on cardiovascular morbidity and mortality. The importance of the peak/valley relationship in the election of anti hypertensive medication is also reviewed.
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PMID:[Advances in the treatment of hypertension]. 1045 15

The aim of the HOT Study (Hypertension Optimal Treatment) was to determine the optimal diastolic blood pressure decrease and to assess the effect of the acetyl salicylic acid as a primary prevention on the cardiovascular morbidity and mortality in hypertensive patients. The HOT Study is an open, prospective, randomised, international trial with blinded end points. This study included 18,790 patients, 50 to 80 years old (mean 61.5 years) in 26 countries (1,574 patients in France) with a primary hypertension (100 < or = PAD < or = 115 mmHg). The patients were randomised in 3 target diastolic blood pressure: < or = 80 mmHg (n = 6,262), < or = 85 mmHg (n = 6,264), < or = 90 mmHg (n = 6,264). The felodipine LP, a long acting dihydropyridine, was selected as a first line therapy, other hypertension drugs combined if necessary. The lowest incidence of cardiovascular events was observed at a diastolic blood pressure level of 82.6 mmHg. There was no increased risk below this level even in the hypertensive patients with medical history of coronary heart disease or stroke. In the diabetic population, the diastolic blood pressure decrease from 90 to 80 reduced the incidence of the major cardiovascular events by 51%. The acetyl salicylic acid reduced the myocardial infarction risk in the blood pressure well-controlled population.
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PMID:[Effect of intensive antihypertensive treatment and of aspirin in a low dose in the hypertensive. The HOT (Hypertension Optimal Treatment) study]. 1048 68

More than 50% of hypertensive patients are aged above 65 years. Physiopathology of essential hypertension is different in the elderly as compared with the young adult. Furthermore, not only are concomitant diseases statistically more frequent in the elderly, but the aging process in itself produces several specific changes in target organs. Several trials have shown that treatment of hypertension in the elderly, including the 'old elderly', is highly beneficial in terms of reduced morbidity and mortality. The therapy used in all these major intervention trials consisted of diuretics and/or beta-blockers. Recently, the Systolic Hypertension in Europe study and the HOT study extended the list of antihypertensive agents with proven beneficial effects on cardiovascular outcomes to dihydropyridine calcium antagonists. Dihydropyridine calcium antagonists, such as lacidipine, have been advocated as first-choice agents for the treatment of hypertension in the elderly on grounds that: a) they may be more active in lowering blood pressure because of the predominantly low renin status in the elderly hypertensives; b) they may be better tolerated because the side effects related to the activation of the sympathetic system may be less frequent as a consequence of the attenuation of baroreflexes during aging; and c) they may have beneficial effects on a variety of concomitant cardiovascular diseases which are frequently present in the elderly. These assumptions are, however, not always proven in the clinical practice. Only well-designed prospective comparative trials may solve this issue. STOP-2, NICS-EH, HYVET, SCOPE and SHELL are acronyms of ongoing clinical trials specifically designed in the elderly hypertensive. The SHELL study assesses the benefits of lacidipine compared with chlortalidone on the prevention of cardiovascular events. The effects of lacidipine (vs atenolol) on the development and progression of carotid atherosclerosis are also being currently investigated in the ELSA study.
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PMID:The potential advantages of a modern antihypertensive therapy in the elderly. 1134 57