Isolated systolic hypertension in very elderly

Globally, hypertension is a common problem in the elderly, and its prevalence increases with increasing age. Isolated systolic hypertension (ISH) subset is more common in the very elderly population, and as the population ages, its prevalence will rise more and more. In the past, treatment of hypertension (HT) in the very elderly was controversial and either no treatment or complications of treatment risk overweigh the benefits observed. The inclusion of elders in various clinical trials has demonstrated a better understanding and rational approach toward optimal management of HT. Systolic blood pressure (BP) is more important in predicting adverse cerebrovascular outcomes and decline in renal function in elderly patients with ISH. Early detection, protection of target organs, correction of high BP will develop, promote, and corroborate healthy aging.

Undiagnosed Isolated Systolic and Diastolic Hypertension Subtypes and Their Correlates in Bangladesh: A Nationwide Survey

OBJECTIVES: This study was performed to identify the distribution of undiagnosed isolated hypertension subtypes and their correlates amongst adults aged 35 years and older in Bangladesh using data from the Bangladesh Demography and Health Survey 2011. METHODS: Out of a total of 17,964 selected households, 7,880 were included in the final analysis for this study. Systolic and diastolic blood pressure (BP) were measured 3× at 10-minute intervals. Hypertension subtypes were defined for individuals not under antihypertensive treatment as systolic-diastolic hypertension (SDH): systolic BP (SBP) ≥ 140 mm Hg and diastolic BP (DBP) ≥ 90 mm Hg; isolated diastolic hypertension (IDH): SBP < 140 mm Hg and DBP ≥ 90 mm Hg, and isolated systolic hypertension (ISH): SBP ≥140 mm Hg and DBP < 90 mm Hg. RESULTS: The predominant hypertension subtypes were SDH and IDH [5.2%; 95% confidence interval (CI): 4.7–5.1] followed by ISH (3.8%; 95% CI: 3.4–4.2). Multiple logistic regression showed that age and gender were significant predictors of ISH. SDH was associated with females [odds ratio (OR): 1.8; 95% CI: 1.3–2.6], the older age group (OR-7.4; 95% CI: 4.3–12.7), and overweight or obese individuals (OR: 1.6; 95% CI: 1.1–2.4). Non-manual work (OR: 1.5; 95% CI: 1.0–2.0]) and being overweight or obese (OR: 1.9; 95% CI: 1.4–2.8) were factors associated with IDH. CONCLUSION: ISH, IDH and SDH represent salient subtypes of hypertension in Bangladesh. To identify preventive intervention for averting adverse cardiovascular events, further research is needed.

Atherosclerosis of subjects with isolated systolic hypertension, and some risk factors in which affected / Монголын Анагаах Ухаан

Introduction@#It has been found that morphological changes of elastic and elastic-muscular arteries wall are the main role in elevation of systolic blood pressure. Furthermore, Isolated systolic hypertension (ISH) has been found that to be associated with cerebral stroke, myocardial infarction and heart failure. And according to national study of prevalence of risk factors on non-communicable disease, it found that risk of CVDs (cardiovascular diseases) is a high among Mongolian and one fifth has more than 3 risk factors of atherosclerosis. The researchers found that atherosclerosis begins relative in young people and endothelial dysfunction is without clinical signs of CVD among Mongolian.@*Purpose @#To determine the atherosclerotic changes and associated with some risk factors of subjects with Isolated systolic hypertension.@*Materials and Methods@#We used hospital-based cross-sectional study design. Data collection was conducted using questionnaire, body measurement, and laboratory methods. A standardized questionnaire was used according to the methodology from the “STEPs” Survey on the prevalence of Non-communicable disease and injury risk factors, body weight, height and blood pressure were measured by standard method. @*Results @#In group with ISH, maximal IMT of CCA was 1.46±0.44mm, systolic diameter was 5.89±0.68mm, diastolic diameter was 6.34±0.73mm respectively which were significantly higher than normotensive group (1.21±0.28mm, 5.58±0.59mm, 5.99±0.58mm) (p<0.05). Furthermore we studied plaques of carotid artery, and atherosclerotic plaques were revealed in 69.2 percent of subjects with ISH which was significantly higher compared with normotensive subjects (p=0.003). And resistive, pulsative and stiffness indexes were significantly higher in group with ISH which represents vascular resistance of CCA. But end-diastolic velocity of CCA significantly reduced in group with ISH (p=0.015). We found that atherosclerotic index increases every year by 6.5 percent, every one mm Hg of systolic blood pressure by 3.7 percent and every year of increasing blood pressure by 10.5 percent respectively.@*Conclusion@#</br> 1. Atherosclerotic changes were revealed more in subjects with ISH compared to subjects with normotensive. </br> 2. Advancing age, long duration of smoking, a high level of systolic blood pressure, having a high systolic blood pressure level for a long time and high consumption of salt intake are accelerating atherosclerotic changes of carotid artery. </br> 3. According to increasing atherosclerotic change, blood stream velocity of carotid artery is decreasing and resistive and pulsative indexes are increasing.

Criterios y actitudes de grupos de médicos sobre la hipertensión sistólica aislada / Criteria and attitudes of groups of doctors on isolated systolic hypertension

Introducción: la hipertensión arterial sistólica aislada es un riesgo importante para la salud, por ser la expresión de la fase final del remodelado vascular, por su alta frecuencia y morbilidad y mortalidad asociadas. Representa entre el 45 por ciento y el 76 por ciento de los hipertensos no controlados. Objetivos: identificar criterios diagnósticos y terapéuticos sobre la hipertensión arterial sistólica aislada de médicos de diferentes especialidades clínicas de la ciudad de La Habana. Métodos: se realizaron tres encuestas a 1 098 médicos especialistas de la ciudad de La Habana por el mismo autor en los periodos, 2001-2005, 2006-2010 y 2015-2016 para dar respuestas a 4 preguntas básicas: ¿Cuál fue el criterio empleado para su diagnóstico?, ¿Cuáles eran las fuentes de conocimientos?, ¿Qué medidas terapéuticas empleaban para su tratamiento? ¿Cuáles fueron las metas de presión arterial sistólica a alcanzar? Resultados: entre el 23,2 por ciento y el 59,2 por ciento de los encuestados utilizan el 4to ruido de Korotkoff para el diagnóstico de la presión arterial diastólica. Las guías de consensos fueron utilizadas entre el 42,2 por ciento y el 8 por ciento y las cubanas entre 40,2 por ciento y el 79,2 por ciento, mientras que la experiencia clínica osciló entre el 78,8 por ciento y el 98,9 por ciento. El 100 por ciento emplean tratamiento no farmacológico. En el tratamiento farmacológico, los diuréticos (70 por ciento-85 por ciento) fueron la primera opción. La mayoría de los médicos encuestados inician tratamiento farmacológico con cifras a partir de hipertensión arterial sistólica de 140 mm Hg. Hasta un 40,7 por ciento en algunas de la encuestas no consideró necesario utilizar de medicamentos antihipertensivos en mayores de 60 años. Entre el 36 por ciento y 69 por ciento lo inician en menores de 60 años teniendo como meta presiones igual a 140 mmHg y entre 23 por ciento y el 74,4 por ciento en los mayores de 60 años usando de 140 mmHg como meta de tratamiento. Conclusiones: un tercio de médicos de especialidades clínicas emplea el 4to ruido de Korotkoff como técnica para medir la hipertensión sistólica aislada. Insuficiente utilización de las guías, tanto nacionales como las extranjeras. El tratamiento no farmacológico fue universalmente aceptado, no así el farmacológico, siendo los diuréticos la primera opción terapéutica. Hay especialistas que son tolerantes y no tratan adecuadamente la HSA, sobre todo en pacientes con 60 o más edad. La gran mayoría de los encuestados utilizan como objetivo del tratamiento cifras iguales o inferiores a 140 mmHg de presión arterial sistólica. Se necesita actualizar conceptos y criterios sobre la HSA(AU)

Introduction: Isolated systolic arterial hypertension (SAH) is an important risk for health, as it is the expression of vascular remodeling final phase, due to its high frequency and associated morbidity and mortality, representing between 45 percent - 76 percent of uncontrolled hypertensive patients. Objectives: Identify diagnostic and therapeutic criteria on isolated systolic arterial hypertension of professionals from different clinical specialties in Havana. Methods: Three surveys were conducted in Havana by the same author in 2001-2005, 2006-2010 and 2015-2016 to answer four basic questions: What was the criterion used for diagnosis? What were the sources of knowledge? What therapeutic measures did doctors use for their treatment? What were the goals of systolic blood pressure to achieve? Results: The respondents who used the 4th korotkoff noise for diastolic blood pressure diagnosis ranged between 23.2 percent and 59.2 percent. Consensus guidelines were used between 42.2 percent and 8 percent and the Cuban guidelines were used between 40.2 percent and 79.2 percent, while clinical experience ranged between 78.8 percent and 98.9 percent.100 percent uses non-pharmacological treatment. In the pharmacological treatment, diuretics (70 percent -85 percent) were the first option. Most of the doctors surveyed started pharmacological treatment with figures from systolic arterial hypertension of 140 mmHg. In some of the surveys, up to 40.7 percent do not consider it necessary to use antihypertensive drugs in people over 60 years of age. Those who started in patients under 60 years of age ranged between 36 percent and 69 percent with a target pressure of = 140 mmHg and between 23 percent and 74.4 percent in those over 60 using 140 mmHg as a treatment goal. Conclusions: One third of physicians of clinical specialties use the 4th korotkoff noise as a technique to measure isolated systolic hypertension. Insufficient use of the guides, both national and foreign was observed. The non-pharmacological treatment was universally accepted. Diuretics are still the first pharmacological option treatment. There are specialists who are tolerant and do not treat systolic arterial hypertension adequately, especially in patients older than 60 years. The vast majority of the respondents used figures of equal to or less than 140 mmHg systolic blood pressure as the treatment goal. It is necessary to update concepts and criteria about systolic arterial hypertension(AU)

Is Chinese herbal medicine effective for elderly isolated systolic hypertension? A systematic review and meta-analysis / 中国结合医学杂志

<p><b>OBJECTIVE</b>To study the efficacy of Chinese medicine (CM) on isolated systolic hypertension.</p><p><b>METHODS</b>Seven electronic databases were searched for randomized controlled trials (RCTs) published until August 2015. Subgroup analyses and meta-analysis were performed to assess the efficacy and safety of the included studies.</p><p><b>RESULTS</b>A total of 24 studies, including 2,096 patients (1,058 patients in the intervention group and 1,038 in the control group), were evaluated in the final analysis. Compared with a conventional therapy used alone, CM as additional intervention was more effective on systolic blood pressure [mean difference (MD)=-0.66, 95% confidence interval (CI)=(-0.97,-0.36), P<0.00001] and significantly diminished the pulse pressure [MD=-7.49, CI=(-12.69,-2.29), P<0.00001]. However it showed no additional benefit on diastolic blood pressure [MD=1.16, CI=(0.02, 2.29), P=0.87]. Adverse events were not explicitly reported in most RCTs.</p><p><b>CONCLUSIONS</b>CM might be a promising approach for the elderly with isolated systolic hypertension, while the evidence for CM employed alone was insufficient. Considering the inherent limitations of the included studies, larger high-quality RCTs with extensive follow-up should be performed to validate our findings in the future.</p>

The relationship between the prevalence of isolated systolic hypertension and the stages of chronic kidney disease in chronic kidney disease outpatient clinic / 中华肾脏病杂志

Objective To investigate the relationship between the prevalence of isolated systolic hypertension (ISH) and the stages of chronic kidney disease (CKD) in chronic kidney disease outpatient clinic.Methods CKD patients of stages 1,2,3,4 and 5 were recruited (n=626).Based on office systolic pressure (SBP) and diastolic pressure (DBP),they were classified into four subtypes:normotension (＜ 140/90 mmHg),isolated diastolic hypertension (IDH,SBP ＜ 140 mmHg and DBP ≥ 90 mmHg),ISH (SBP≥ 140 mmHg and DBP ＜ 90 mmHg) and systolic-diastolic hypertension (SDH,SBP≥140 mmHg and DBP≥90 mmHg).Results The control rate of blood pressure was 86.4％,75.6％,65.3％,51.0％ and 37.0％ at CKD stage 1,2,3,4 and 5,respectively,which decreased with the advancement of CKD.There was a stepwise increase in the prevalence of ISH (0,9.2％,23.9％,28.6％ and 37.0％ at CKD stage 1,2,3,4 and 5,respectively) and SDH (4.5％,8.4％,8.0％,17.3％,21.9％ at CKD stage 1,2,3,4 and 5,respectively).Logistic regression analysis showed that age,diabetes and CKD stages were independent predictors of ISH.Compared with CKD stage 1-2,CKD stage 3,4 and 5 showed 2.388,2.697 and 5.980 folds risk in developing ISH.Conclusion The prevalence of ISH increases correspondingly with the advancement of stages of CKD,which may partially contribute to the increased cardiovascular mortality during the progress of CKD.

Prevalence and Trends of Isolated Systolic Hypertension among Korean Adults: the Korea National Health and Nutrition Examination Survey, 1998-2012

BACKGROUND AND OBJECTIVES: Systolic and diastolic blood pressure may have different effects on cardiovascular disease, but limited data is available for hypertension subtypes in the Korean population. Thus, the prevalence, and absolute number of hypertension subtypes among Korean adults was estimated. SUBJECTS AND METHODS: The Korea National Health and Nutrition Examination Survey 1998-2012 was used to estimate the prevalence and absolute number of each hypertension subtype among Korean adults aged > or =20 years. Hypertension was classified into four subtypes: treated hypertension (TH), isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH). RESULTS: In 2012, approximately 9.5 million adults were estimated to have hypertension, which consists of 5675671 TH (60.0%), 954253 ISH (10.1%), 1649486 IDH (17.4%), and 1175506 SDH (12.4%). Between 2010 and 2012, the proportion of IDH steadily decreased with age, but ISH increased especially in older ages (> or =40). Between 1998 and 2012, TH markedly increased from 1.4 million to 5.7 million while the number of untreated hypertension remained relatively constant. During the same time, the number of hypertensive elderlies increased from 507000 to 2822000 along with rapid ageing of the Korean population. Despite of significant improvement in treatment rate, there are still around 583000 elderlies with untreated hypertension (423000 ISH; 42000 IDH; 118000 SDH) as of 2012. CONCLUSION: Although the prevalence of hypertension has been constant over the last decades, absolute number of people with hypertension has been increasing. Along with the rapid population ageing, the number of elderly hypertension is increasing and the ISH is also becoming more prevalent.

Effect of kidney-supplementing and blood-activating method on expression of Malb and RBP in senile patients with isolated systolic hypertension / 国际中医中药杂志

Objective Kidney-supplementing and blood-activating method was adopted in treating senile patients with isolated systolic hypertension to observe its decompression effects and influences on microalbunminuria (Malb),retinol binding protein (RBP) level in 24 hours.Methods 90 patients with simple systolic hypertension were randomly recurited into two groups.52 cases in the treatment group were administered with kidney-supplementing and blood-activating decoction,including 1 case falling off and 51 cases entering statistical analysis; 38 cases in the control group were administered with oral placebo,among them 2 cases were fallen offand 36 cases were entered statistical analysis.Both groups were treated for 8 weeks.Results () Blood pressure:systolic blood pressure at 4 and 8 weeks after the treatment in the treatment group [(144.03±12.33)mmHg (1 mmHg=0.133kPa) and (132.27±13.15)mmHg] wassignificantlyimproved than before the treatment [(156.32±12.05)mm Hg] (P＜0.05),and also significantly better than the control group at 4,8 weeks after the treatment [(151.19± 13.83)mm Hg,(152.74± 12.03)mm Hg] (P＜0.05).②The Malb,RBP level:Malb,RBP level [(40.80±13.51)mg/L,(150.43±23.62)mg/L] after the treatment in the treatment group was reduced than before the treatment [(50.14± 15.61)mg/L,(220.04±30.20) mg/L] (P＜0.05),and was significantly different to the control group after treatment [(52.12±14.69)mg/L,(219.34±34.37)mg/L] (P＜0.05).Conclusion Kidney-supplementing and blood-activating method can improve kidney function,and thus to reduce the effect of systolic blood pressure.

Isolated systolic hypertension and physical activity / Монголын Анагаах Ухаан

IntroductionIsolated systolic hypertension (ISH) has been found to increase the risk of stroke and coronary heart disease significantly among both middle-aged and elderly men and women. ISH is a higher risk factor for cardiovascular diseases (CVDs) than isolated diastolic hypertension. Because of this it is important to determine the prevalence of ISH and its associated risk factors in order to reduce CVD mortality and morbidity in Mongolia.ObjectivesThe aim of the study was to compare the physical activity of people with ISH to it of people with normal blood pressure (BP).Мaterials and MethodsWe examined the physical activity using the data of “Mongolian STEPS Survey on the Prevalence of Noncommunicable Disease and Injury Risk Factors-2009”. ISH was defined as systolic BP≥140 mmHg and diastolic BP<90 mmHg. The Control (normotensive) group comprised subjects whose systolic BP<140 mmHg and diastolic BP<90 mmHg. Using to approach of WHO “STEPS” Survey, physical activity was assessed on intensity, duration and frequency of physical activity at work, in recreational settings and during transportation using complex set of 16 questions.ResultsAccording to the survey results, 74% of people who had normal BP and 48.7% of people with ISH engaged in moderate levels of physical activity in recreational settings daily a week. It was statistically difference in two groups. Males with ISH were more likely to engage in high levels of physical activity at work and in recreational settings compared to females. In terms of age differences, moderate and high levels of physical activity at work decreased steadily with age. Mean duration and frequency of physical activity a week weren”t difference in two groups.ConclusionFrequency of physical activity decreased with age in respondents with Isolated systolic hypertension. Males engaged more in high levels of physical activity at work and in recreational settings more than females. Moderate levels of physical activity in recreational settings was lower in respondents with ISH compared to respondents who had normal blood pressure (p<0.05).

Effect of Benidipine-atorvastatin Combination Therapy on Inflammatory Markers and Flow-mediated Dilatation in Elderly Patients with Isolated Systolic Hypertension / 中华高血压杂志

Objective The effect of combined treatment of statins and calcium channel blockers(CCB) in elderly patients with isolated systolic hypertension(ISH) are not well understood.The purpose of the present study was to assess the additive effect of benidipine-atorvastatin combination therapy in old patients with ISH.Methods Ninety patients with ISH were randomized to receive: placebo(n=15),benidipine treatment(4-8 mg/d,n=25),atorvastatin(20 mg/d,n=25) and benidipine plus atorvastatin treatment(4-8 mg/d+20 mg/d,n=25) for 5 months.Serum concentrations of IL-6,IL-8,hsCRP,flow-mediated dilatation of the brachial artery,urine microalbumin,left ventricular mass index(LVMI),carotid intima-media thickness(CIMT),BP and plasma lipids profiles were examined before and after treatment.Results After 5-months of treatment,the combination treatment significantly reduced IL-6(IL-6 reduction magnitude,combination group: 6.5+6.3 ng/L vs benidipine group: 3.1?3.2 ng/L vs atorvastatin group: 3.3?2.3 ng/L,P

The Research of Pulse Wave Velocity and Heart Rate Variability in patients with Isolated Systolic Hypertension / 中华高血压杂志

Objective To investigate the characteristics of pulse wave velocity(PWV)and heart rate variability (HRV)and evaluate their feasibility in grading the cardiovascular risk in patients with isolated systolic hypertension (ISH).Methods Eighty-nine ISH patients and systolic-diastolic hypertension patients(DH,n=98)admitted in our hospital were submitted carotid-radial PWV(crPWV),carotid femoral PWV(cfPWV)and HRV,ISH patients were categorized depending on their risk grade as:low risk group(n=3),moderate risk group(n=17),high risk group(n=35)and very high risk group(n=34).Results The cfPWV in ISH patients is significantly higher than that of sys-diastolic hypertension group(ISH: 399.6?48.2 vs sys diastolic hypertension:374.3?39.7 cm/s,P0.05).The LF in ISH group are markedly higher than those in DH(ISH:4.35?1.07 log ms~2 vs 3.78?0.82 log ms~2,P 0.05).LF are markedly positive correlated with the degree of the total cardiovascular risk(rs=0.438,P

Impact of Age and Vascular Endothelial Function on Arterial Stiffness in Isolated Systolic Hypertersion / 中华高血压杂志

Objective To investigate the impact of aging and vascular endothelial function on arterial stiff- ness in patients with isolated systolic hypertension.Methods Patients with isolated systolic hypertension (ISH,n=75)age-matched healthy subjects(n=30)and young healthy subjects(n=50)were submitted to deter- mination of aortic pulse wave velocity(baPWV)and vascular endothelial function evaluated by flow-mediated dila- tion(FMD).Results baPWV was progresively decreased(ISH:2459.2?436.8 vs elderly healthy:2097.2? 315.7 vs young healthy:1619.7?214.2 cm/s,P

Effect of probucoi on the vascular endothelial function of old patients with isolated systolic hypertension / 中国基层医药

Objective To evaluate the effect of probucol on endothelium-dependent vasodilatation(i,e.flow- mediated dilation,FMD) function of the old patients with isolated systolic hypertension.Methods In this single- blind study,a total of 64 old pariems with isolated systolic hypertension were randomized to receive conventional an- tihypertensive therapy and probucol (0.5g twice daily,group A,n=33) or receive conventional antihyperrensive therapy(group B,n=31) for 12 weeks.The levels of blood lipid were measured and vascular endothelial function was assessed in the brachial artery by high-resolution ultrasound technique in form of endothelium-dependent vasodi- latation before and after treatment.Results After 12-week treatment,the levels of TC,LDL-C and HDL-C in group A were significantly reduced compared with those before treatment(all P0.05).Flow-mediated dilatation parameters in both groups were obviously improved compared with those before treatment( P

The Prevalence of Isolated Systolic Hypertension Among Routine Health Examines in A University Hospital in Korea

OBJECTIVES: Recently, there are many studies that highlights the importance of the systolic blood pressure and pulse pressure as a better prognostic factor than diastolic blood pressure especially in older persons. In this study, we investigated the prevalence of isolated systolic hypertension in the elderly aged more than 60 years old who visit to hospital for routine health exam. METHODS: This study was done in one university hospital in a mid-sized city in Kyungki-provine of Korea, during one year from Feb. 1st, 2005. The study participants were people aged 60-yr-old or over who came to hospital for taking routine health examination offered by Korea's national health insurance corporation. We investigated the proportion of the isolated systolic hypertension among untreated hypertension by double-checked blood pressure. Besides we got information about eating habits, drinking and smoking status, exercise and stress, fasting blood glucose, serum total cholesterol, proteinuria and hematuria by standardized questionnaire and blood and unine test. RESULTS: The total number of participants were 2,480. Among them, 1,181 persons (47.6%) were males, 1,299 persons females (52.4%). 1,706 persons (68.8%) were in their sixties, 774 persons (31.2%) in their seventies or more. In males, 494 (41.8% of total males) had hypertension. Among 211 males with untreated hypertension, 109 (51.7%) had isolated systolic hypertension (ISH). In females, 551 (42.4% of total temales) had hypertension. Among 201 females with untreated hypertension, 132 (65.7%) had ISH. In male, body mass in dex (BMI), fasting blood gulcose and total cholesterol were significantly associated with ISH. In female BMI, age, drinking status were significant. In female, drinking status was a protective factor. CONCLUSIONS: In Korea older people aged 60 or more, isolated systolic hypertension is occupying most part of hypertension. As Korea is entering into a rapidly aging society, from now on, older persons with isolated systolic hypertension is expected to increase rapidly. In the future, The more studies and more active treatment for isolated systolic hypertension is to be required.

Amlodipine and hydrochlorothiazide for isolated systolic hypertension in the Thai elderly.

Objective: 1) To compare the efficacy of two drugs, Amlodipine and hydrochlorothiazide (HCTZ), in elderly Thai patients with isolated systolic hypertension (ISH) in terms of regression of left ventricular hypertrophy (LVH) and blood pressure control. 2) To detect the short (six months) and medium (18 months) terms of clinical outcomes of major cardiovascular events, i.e., congestive heart failure (CHF), myocardial infarction (MI), cerebrovascular disorders (CVD), death and minor clinical outcomes or adverse drug effects. This is a prospective randomized control study. Methods: From October 1997 to March 2000, 200 elderly patients with ISH, mean age of 69.3 years, were randomized into two groups, to receive either Amlodipine or HCTZ as a primary drug. Their baseline clinical data, blood chemistry, ECG, and echocardiography (ECHO) were evaluated. Regression of LVH was re-examined at six months; BP measurement was measured every 3 months for 18 months; and, clinical outcomes were followed at the end of study. Clinical end points were defined as death, myocardial infarction, and congestive heart failure. Results: Sixty-six percent of all patients had LVH by the ECHO criteria. After six months of monotherapy, there was regression of LVH in both groups (p < 0.01), but no difference in the reduction of LVMI between the two groups (p = 0.33). There was a significant reduction in BPsys in both treatment groups (p < 0.01). Those who received Amlodipine had more frequent side effects and were withdrawn from the study (p =0.02). The major adverse drug effect was leg edema (Amlodipine). However, more patients in the HCTZ group required additional drugs (Prazosin) in order to control BP to the desired level (39.2% vs 14.5%, p < 0.001). There was no statistical difference in clinical end points during follow-up. Difference of total drugs costs for one year of treatment was 8,084 Baht/patient in favor of the HCTZ regimen. Conclusion: It is suggested that a low dose of the HCTZ regimen is more cost effective when compared with Amlodipine and should be considered as the first antihypertensive agent of choice for ISH in the Thai elderly.

Impact of saiga horn capsule on blood pressure variability,pulse pressure and left ventricular mass in elderly patients with isolated systolic hypertension / 中华中医药杂志

Objective:To observe the efficacy of saiga horn capsule combining with benazapril on blood pressure variability,pulse pressure and left ventricular mass in elderly patients with isolated systolic hypertension (ISH).Methods:78 elderly patients with ISH were treated with saiga horn capsule combining with benazapril for 4 months.We compared the change of 24hours systolic blood pressure (SBP),24hours diastolic blood pressure (DBP),pulse pressure (PP) and left ventricular mass.Results:After four months treatment,reduction of 24 hour SBP variability,day SBP variability,DBP variability,night SBP variability day,24 hour and day average BP variability,pulse pressure and left ventricular mass had statistical signifi cance (P0.05).Conclusion:The elderly patients with ISH treated with saiga horn capsule and benazapril can lower blood pressure,pulse pressure more effective,therefore protect target organ better than with benazapril only.

Effect of the nitrates combined therapy of decreasing blood pressure and lowering lipid on isolated systolic hypertension in elderly / 中国康复理论与实践

@#ObjectiveTo observe the effect of nitrates and statins on blood pressure,serum lipid and artery structure of elderly patients with isolated systolic hypertension(ISH) and hyperlipidemia.Methods96 elderly patients with ISH and hyperlipidemia were randomly divided into the isosorbide mononitrate triple therapy group(group A),simvastatinelderly two drugs combination group(group B) and control group(group C) with 32 cases in each group.The group A was given isosorbide mononitrate,simvastatinelderly and felodipine.The group B was given simvastatinelderly and felodipine.The group C was given felodipine alone.The whole course lasted 12 weeks and the blood pressure,serum lipid and the change of artery structure were observed.ResultsThe effect of group A was significantly better than groups B and C(P<0.01). The effect of lowering serum lipid and change of artery intima-media thickness(IMT) in groups A and B were better than that in group C(P<0.05).ConclusionNitrates can decrease systolic blood pressure and pulse pressure,but has less effect on diastolic blood pressure.Statins can decrease IMT of the common arteries.The combination of nitrates and statins is speculated beneficial to elderly with ISH.

Cardiovascular Disease in the Elderly

No abstract available.

The therapeutic effects of intermittent hypoxia therapy in isolated systolic hypertension patients / 中华物理医学与康复杂志

Objective To study the therapeutic effects of intermittent hypoxia therapy(IHT)in isolated systolic hypertension(ISH)patients with elevated cerebral blood flow velocity(Vp),and to explore the mechanisms involved.Methods Seventy-six ISH patients with increasing Vp and normal pulsatility index(PI)of the middle ce- rebral artery(MCA)were randomly divided into a therapy group and a control group.IHT was administrated in the therapy group,and air in the control group.The Vp and PI of the MCA and blood pressure(BP)were observed be- fore and after treatment.Results Vp and systolic blood pressure(SBP)were significantly reduced after IHT(P＜0.01)compared with the therapy group's scores betore treatment,but PI and diastolic blood pressure showed no sig- nificant difference.There was no significant change in BP,Vp or PI in the control group before or after treatment. Conclusion IHT has therapeutic effects on ISH by reducing Vp and moderating SBP.

A study on heart rate variability and its circadian rhythm of patients with isolated systolic hypertension / 重庆医科大学学报

Objective:To investigate heart rate variability(HRV)and its circadian rhythm of patients with isolated systolic hypertension.Methods:HRV was evaluated by using 24-hour Holter monitoring in 92 isolated systolic hypertensive patients, and compared with age-matched normal controls.Furthermore,HRV and its circadian rhythm were evaluated in two subgroups with and without left ventricular hypertrophy(LVH).Results:All HRV time domain index were lower among patients than normal controls.As compared with the patients with and without LVH,rMSSD and pNN50 were significantly decreased in patients with LVH.The circadian rhythm was blunted in patients without LVH,but it was absent in patients with LVH.Conclusion:Our results suggest that HRV is decreased in isolated systolic hypertensive patients.Parasympathetic tone is lower in patients with LVH than those without LVH,and the sympathetic/parasympathetic tone is altered.