Is isolated systolic hypertension in the elderly more associated with left ventricular hypertrophy and significant carotid artery stenosis than mixed hypertension and isolated diastolic hypertension?

The association of electrocardiographic left ventricular hypertrophy (ECG-LVH) (212 subjects) and haemodynamically significant internal carotid artery stenosis (ICAS) (27 subjects) with isolated systolic hypertension (ISH), mixed hypertension (MHT) and isolated diastolic hypertension (IDH) was studied in untreated elderly patients. Subjects were those aged 67-86 years, drawn from a community screening programme for hypertension in Wales. The prevalence of ECG-LVH with or without repolarisation abnormalities was higher in subjects with ISH (16.6%) than in subjects with mixed hypertension (11.6%, NS). Partial correlation of SBP, DBP, voltage of lead I and SV1+RV5 for each hypertensive subtype showed a consistent positive correlation of DBP with the voltage of lead I and SV1+RV5 in all the subtypes except with the voltage of lead I in IDH subjects. In MHT, the SBP was inversely related to both the voltage of R-wave in lead I and SV1+RV5 (P < 0.03). In IDH, the SBP was positively correlated with the voltage of R-wave in lead I and inversely with SV1+RV5. Atheromatous plaque was present in 40 of 54 (74.1%) internal carotid arteries investigated. The homogeneous type of plaque was predominant in ISH (67%). Heterogenous type of plaque was predominant in the MHT group (50%) and IDH group (43%). The normotensive group did not show any predilection to any morphological type. Plaque was invariably present in the case of ISH, chi 2 = 12.29, 0.1 > P > 0.05. There was more smooth plaque surface in normotensives (79%) and more rough or pitted plaque surface in hypertensives (all types), chi 2 = 6.51, 0.1 > P > 0.05. All normotensives and IDH subjects had non-haemodynamically significant stenosis. Haemodynamically significant stenosis was found in cases of ISH (25%) and MHT (7%); chi 2 = 7.66, 0.1 > P > 0.05. ECG-LVH and haemodynamically significant internal carotid artery stenosis were more commonly found in subjects with ISH than in subjects with MHT. Further studies with larger numbers of patient in each hypertensive subtype would be desirable to confirm these observations.

Prevalence of mixed hypertension, isolated systolic hypertension and isolated diastolic hypertension in the elderly population in the community.

The prevalence of mixed hypertension (MHT), isolated systolic hypertension (ISH) and isolated diastolic hypertension (IDH) was estimated in the elderly population in the register of a large general practice in Wrexam, North Wales. Of the 3289 elderly patients, born in 1927 or before, entered in the register of surgery, 1901 attended for the first screening. The mean SBP rose with age until the age of 80-84 years in males and 75-79 years in females and then gradually declined. The mean DBP showed an earlier decline in males than in females. The prevalence of hypertension at first screening was: mixed hypertension 9.8%, ISH 19.1% (DBP < 95 mmHg*, 23.1%*) and IDH 5.7% with a total prevalence of hypertension of 52.2%. The prevalence fell at each subsequent screening so that at the third screening MHT was 3.9%, ISH 4.2% (5.4%)* and IDH 1.0%, with a total prevalence of hypertension of 10.3%. The prevalence of ISH rose with age until 70-74 years of age and with the maximum prevalence in this age group and then gradually declined. There was a drastic drop in the prevalence of both mixed hypertension and IDH after the age of 70-74 years. This study provides data for this community and also supports earlier observations that hypertension is a common problem in the elderly and that ISH is the commonest form of hypertension in the elderly. It confirms the fall in mean DBP with age but reports a decline also in mean SBP after the age of 80-84 years in males and 75-79 years in females.(ABSTRACT TRUNCATED AT 250 WORDS)

A double-blind, placebo-controlled parallel trial of vitamin C treatment in elderly patients with hypertension.

We have investigated the effect on blood pressure of treatment with vitamin C (an antioxidant and free radical scavenger) in patients with both systolic and essential hypertension. Following a 2-week run-in phase, two age- and sex-matched groups of untreated hypertensive subjects were randomised in a double-blind study to receive 6 weeks' oral treatment with either vitamin C, 250 mg twice daily (n = 22; 8M/14F, mean age 73.7 +/- 4.9 years) or placebo, one capsule twice daily (n = 26; 10M/16F, mean age 73.8 +/- 5.3 years). Blood pressure was measured in the sitting position using a random zero sphygmomanometer on three occasions during the run-in phase, and again at 2, 4 and 6 weeks after commencing treatment. Venous blood samples for measurement of plasma ascorbic acid (AA) and lipid peroxides (LP) were measured in all subjects at baseline and at 4 and 6 weeks after the start of vitamin C or placebo treatment. During the study period, significant falls in both systolic (vitamin C group, mean change -10.3 (95% CI 0.7-20.0) mm Hg, p = 0.05) and diastolic (vitamin C group, mean change -5.9 (95% CI 0.2-11.5) mm Hg, p = 0.03; placebo group, mean change -4.7 (95% CI 0.3-9.1) mm Hg, p = 0.05) blood pressure occurred. However, no statistical difference between the effects of either treatment on blood pressure was observed. At baseline, AA concentrations were lower in the vitamin C-treated group compared with the placebo group (44.6 +/- 2.4 vs. 57.7 +/- 4.2 mumol/l, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Isolated systolic hypertension in the elderly: survey of practitioners' attitude and management.

A postal survey of 445 medical practitioners was carried out in the light of recent large studies supporting the treatment of isolated systolic hypertension (ISH) in the elderly. The response rate was 60.2%. 46% of the respondents would consider using drug therapy for ISH, and this was dependent on the patients age and the level of systolic blood pressure. Thiazide diuretic was the most popular first choice drug. The most recurring reason for not using drug therapy by 54% of medical practitioners was that treatment with drugs will reduce quality of life due to side effects of drugs. There was a large consensus on the use of non-pharmacological treatment of ISH in the elderly.

Demographic, life style and anthropometric correlates of blood pressure of Nigerian urban civil servants, factory and plantation workers.

Demographic, life style and anthropometric correlates of blood pressure were analysed in 5,200 civil servants, factory and plantation workers living in an urban setting in the South Eastern part of Nigeria. The subjects were 4,382 men (84.2%) and 818 (15.8%) women. The prevalence of hypertension, using the WHO criteria among the workers was 8.1%, and was lower in women than men, 3.5% and 8.9% respectively. Only 19.6% of the hypertensive population knew that they had hypertension, whilst 29.4% of the total population under study gave a positive family history of hypertension. The blood pressure and the prevalence of hypertension rose with age, number of children in the family, salary scale and with the number of cigarettes smoked per day. The prevalence of hypertension was higher in medium and heavy drinkers than the non-drinkers and light drinkers. The prevalence was also higher in medium and heavy smokers. Multiple regression analysis showed a significant positive relation between the systolic blood pressure and sex, age, marital status, number of children in the family, salary scale, tobacco consumption and weight (P less than 001). On the other hand, occupation (P less than 01) educational qualification (P less than 001), support system (P less than 03) and height (P less than 001) had significant negative relationships with systolic blood pressure. There was also a significant positive relation between the diastolic blood pressure and number of children in the family (P less than 002) and salary scale (P less than 001). It is suggested that hypertension screening and treatment should be incorporated in the primary health care programmes of African communities.

A disappearing urban/rural blood pressure difference in Nigerian children: an evaluation of possible determining factors.

Urban Nigerian school children are reported to have a higher systolic blood pressure and diastolic blood pressure than rural community school children until the age of 11-12 years when this difference tends to disappear. We evaluated 874 urban day-school children and 674 rural community school children aged 5-16 (mean 11.9) years in south-eastern Nigeria to confirm this changing pattern, and to assess the contributions of some known factors to the differences as well as the changing pattern. This study confirmed the changing pattern of urban/rural blood pressure of school children. Differences in weight, height and Body Mass Index (BMI), though important, appeared insufficient to explain this pressure difference and the changing pattern. Urban children aged 12-14 years were found to excrete more sodium and (unexpectedly) more potassium in their 24-h urine samples. The observed urban/rural blood pressure difference appears to be sustained by a multiplicity of factors, including differences in weight, BMI, height, electrolytes (especially sodium) consumption, and increased exposure to Western-type education.

A clinical profile of patients with coronary artery disease in Nigeria.

Observations are reported on 31 patients with coronary artery disease (CAD) from Nigeria (a region where CAD is rare). Hypertension either alone (12 cases), or associated with diabetes mellitus and obesity (4 cases), with diabetes mellitus and heavy cigarette smoking (1 case) was a frequent associated illness. Serum cholesterol measured in 15 cases was high in 13, but nine others without cholesterol assay were in the high socio-economic group, and serum cholesterol was likely to be relatively elevated in them also. Hyper-cholesterolaemia was the one factor that Nigerian patients with CAD had, but which is rare in the Nigerian general population. This observation appears to support the view that other major pre-disposing factors to CAD cause this disease usually when there is a back-ground of hyperlipidaemia.

Cardiovascular complications of tropical pyomyositis.

Clinical observations are described in 13 cases of pyomyositis with various cardiovascular complications: (a) pyogenic pericarditis (10 cases) with tamponade in 7 and myopericarditis in 1 case, and (b) acute bacterial endocarditis (3 cases). Blood cultures grew Staphylococcus aureus in all 3 with endocarditis and in 5 of 10 with pericarditis. These complications probably resulted from the bacteraemia which sometimes complicates pyomyositis. Enhanced susceptibility of cardiac muscles to infection in pyomyositis however remains another possibility.