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Hypertension is quite common in the elderly population. Isolated systolic hypertension and diastolic hypertension are associated with cardiovascular complications. Like younger patients, the elderly may have labile hypertension. On the other hand, pseudohypertension, auscultatory gap, and postural hypotension are peculiar to the elderly. Obesity, atherosclerosis, arteriosclerosis, baroreceptor insensitivity, decline in renal function, physical inactivity, and insomnia are factors that can lead to or aggravate hypertension in older patients. Secondary hypertension should be suspected if elevated blood pressure first appears late in life or becomes resistant to previously adequate treatment. Spontaneous hypokalemia can indicate primary aldosteronism. Elevation in the serum creatinine level of a patient taking an angiotensin-converting enzyme (ACE) inhibitor suggests bilateral renovascular hypertension. The goal of antihypertensive therapy is to prevent morbidity, disability, and death from complications and to maintain quality of life. Psychosocial factors may play an important role in controlling hypertension. Nonpharmacologic treatment, such as weight loss, salt restriction, and exercise, should always be tried prior to and in conjunction with medical therapy. Antihypertensive drugs often cause side effects and should be prescribed with caution. Always start with a low dose and gradually increase it if necessary. All drugs that reduce blood pressure in the younger individual also work in the elderly. ACE inhibitors and calcium blockers are particularly useful because of their low incidence of adverse effects.
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PMID:Hypertension in elderly patients. The special concerns in this growing population. 154 24

Children with asthma frequently have significant anxiety and depression that interfere with treatment outcome. Although the use of antidepressants may be helpful, in the one published study of antidepressant use in pediatric asthma, significant side effects necessitated discontinuance; these side effects were increased motor activity, impulsive behavior, insomnia, postural hypotension, premature auricular contractions, diastolic hypertension, and generalized seizure. The objective of this retrospective chart review was to examine whether antidepressants could be tolerated and administered safely to children on asthma medications. Forty pediatric inpatients (mean age 13.3 years, range 7-19) with varying levels of asthma severity (5 mild, 11 moderate, 24 severe) and an average duration of asthma treatment of 10.0 years were administered antidepressants while also taking an average of 5 medications for asthma (range 2-7). Ten of the patients had an additional comorbid medical diagnosis. There were 17 children diagnosed with a primary affective disorder; 7 with a primary anxiety disorder; and 16 with both an affective and anxiety disorder. Thirty-six children ultimately were continued on an antidepressant: 13 on desipramine, 9 on nortriptyline, 6 on imipramine, 4 on fluoxetine, 3 on bupropion, and 1 on sertraline. Significant cardiovascular side effects (tachycardia, hypertension, and postural hypotension) occurred in 4 subjects on tricyclic antidepressants (TCAs) and 1 subject on a non-TCA (fluoxetine); 3 of these subjects were able to continue treatment with an antidepressant. Two subjects were taken off antidepressants because of hypomanic symptoms (increased motor activity, mood lability, impulsive behavior, and insomnia). No medications were discontinued because of electrocardiogram changes, arrhythmias, or seizures. Doses of TCAs were comparable to those in previous studies, but the asthma medications differed. Discussion of current anti-asthmatic medications and potential for interactions with antidepressants is included.
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PMID:Cardiovascular effects of tricyclic antidepressants in childhood asthma: a case series and review. 919 41

Fifty patients with elevated blood pressure were classified according to 3 sub-groups as follows: 11 with borderline hypertension, 8 with systolic hypertension, and 31 with diastolic hypertension. So far, they have been observed for one year while being treated with an antihypertensive preparation containing pargyline hydrochloride and methyclothiazide. Response to treatment depended in large measure upon the type of hypertension; the borderline type was virtually unchanged; in the systolic type there was some diminution in the systolic, but less in the diastolic pressure; and in the diastolic type there was a reduction in both systolic and diastolic pressures. Side effects (faintness, nervousness, mouth dryness, insomnia, genitourinary disturbances and elevated blood uric acid level), when they occurred, were usually relieved by appropriate alteration of the antihypertensive drug dosage, by a change in the time of administration, or by adding medication directed at treatment of the side effect. Evaluation of cardiac output before and after therapy showed no change in this parameter. The results suggest: (a) that the antihypertensive effect probably was achieved by diminishing the peripheral resistance rather than by reducing the cardiac output, and (b) that there was no deterioration of myocardial efficiency, as measured by cardiac output, during the one-year period of antihypertensive therapy. More knowledge of the natural history of hypertension in each of the 3 sub-groups is required for better assessment of the influence of antihypertensive therapy on the outcome of the disease. Judgment as to the desirability of initiating therapy can in some measure be based on the classification of patients into appropriate sub-groups.
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PMID:Effect of antihypertensive (pargyline hydrochloride-methyclothiazide) therapy in three types of hypertension: preliminary report after one year of observation. 975 84