Is diastolic hypertension an independent risk factor for stroke in the presence of normal systolic blood pressure in the middle-aged and elderly?

In a prospective population-based study from the Copenhagen City Heart Study, the role of diastolic blood pressure as an independent risk factor of stroke, in the presence of normal systolic blood pressure, was assessed in 6,545 subjects aged 50 to 80 years. Follow-up was 12 years. Subjects were divided into various blood pressure categories according to both diastolic and systolic blood pressure. The risk of stroke was assessed using a multivariate Cox proportional hazards model, taking into account various cardiovascular risk factors (age, sex, smoking, diabetes mellitus, body mass index, and levels of serum cholesterol). After adjustment for risk factors, only subjects with elevated systolic blood pressure had a significantly increased risk of future stroke. The risk of stroke according to blood pressure categories further reflected increasing levels of pulse pressure, with the highest risk of stroke in subjects with the greatest pulse pressure. We conclude that systolic blood pressure is a better predictor of stroke than is diastolic blood pressure, and question whether diastolic blood pressure, in the presence of normal systolic blood pressure, is an independent risk factor for stroke in the middle-aged and elderly.

[Isolated systolic hypertension: a significant risk factor of cerebral apoplexy and acute myocardial infarction. A prospective population based study]. / Isoleret systolisk hypertension: en vaesentlig risikofaktor for apoplexia cerebri og akut myokardieinfarkt. En prospektiv populationsbaseret undersøgelse.

The aim of this prospective population based study was to determine the prevalence of isolated systolic hypertension (ISH) and associated cardiovascular risk. ISH was defined as systolic blood pressure > or = 160 mmHg and diastolic blood pressure < 90 mmHg. The associated risk of stroke and myocardial infarction (MI) was assessed using a multivariate Cox regression model. Subjects (n = 6621) were included if aged 50 or older, without antihypertensive or cardiac medicine, and without a previous stroke or MI. The prevalence of ISH increased from 3% among fifty-year olds to 13% among seventy-year olds. No sex difference was found. Adjusted relative risk of stroke was 3.0 (95% CI 1.6-5.3) for women and 2.7 (1.8-4.3) for men when compared to normotensives. Adjusted relative risk of MI was 0.8 (0.3-2.0) for women and 1.6 (1.0-2.5) for men. Population attributable risk percent for stroke associated with ISH is up to 30%.

Isolated systolic hypertension as a major risk factor for stroke and myocardial infarction and an unexploited source of cardiovascular prevention: a prospective population-based study.

The purpose of this study was to determine the prevalence of isolated systolic hypertension (ISH) and associated risk of major cardiovascular events. The Copenhagen City Heart Study is a prospective population survey with cardiovascular examinations at 5-year intervals. Blood pressure measurement was carried out as office blood pressure. ISH was defined as SBP > or = 160 mmHg and DBP < 90 mm Hg. The risk of stroke and myocardial infarction (MI) in association with ISH was assessed using a multivariate Cox regression model. Follow-up was carried out by means of the National Patients Register and Death Register. The 19,698 subjects were randomly selected after age stratification from an area of central Copenhagen. Subjects (n = 6621) were included if > or = 50 years, not on anti-hypertensive or cardiac medicine, and had no history of a previous stroke or MI. Initial cases of verified stroke or MI were recorded from 1976 to 1988. The prevalence of ISH showed an age-related increase from 3% in the 55-year olds to 13% in the 72-year olds. No sex difference was found. Relative risk of stroke corrected for other risk factors was 3.0 (95% CI 1.6-5.3) for women and 2.7 (1.8-4.3) for men. This was the highest relative risk among all hypertensive groups. Relative risk of MI corrected for other risk factors was 0.8 (0.3-2.0) for women and 1.6 (1.0-2.5) for men. Population attributable risk for stroke associated with ISH is up to 30%.(ABSTRACT TRUNCATED AT 250 WORDS)

[Isolated systolic hypertension in the elderly]. / Isoleret systolisk hypertension hos aeldre.

This review article examines the essential literature concerning isolated systolic hypertension in the elderly (ISH). The prevalence of ISH rises curvilinearly with age from approximately 3% at 30 years of age to 25% at 80 years of age, and is more common in women. The pathophysiology of ISH is not yet completely investigated. It seems that the haemodynamics of ISH differ from those of essential hypertension by showing considerably decreased arterial compliance and lack of elevated peripheral resistance. Humoral changes seem very insufficiently investigated. Several studies have shown that ISH is difficult to diagnose because of a high prevalence of white coat hypertension, perhaps in the area of 40%. The treatment of ISH has formerly been debated. Recently published studies have shown beneficial effects of medical antihypertensive treatment in ISH. First choice drugs should be low-dose thiazides and beta-blockers.

Left ventricular mass and geometry in patients with established hypertension and white coat hypertension.

This study was designed to compare the cardiac mass and geometry in white coat hypertensive patients and established hypertensive patients through the prospective comparison of office blood pressure, daytime ambulatory blood pressure, and echocardiographically determined left ventricular mass and cardiac geometry in consecutive patients. We studied 143 patients from general practice in an outpatient hypertension unit. The patients had newly diagnosed mild-to-moderate hypertension prior to the institution of pharmacological anti-hypertensive therapy. All patients had a diastolic office blood pressure above 90 mm Hg; 90 had a consistently elevated diastolic blood pressure (established hypertension), whereas 53 had an average daytime ambulatory blood pressure below 90 mm Hg (white coat hypertension). Left ventricular mass index was significantly higher in the group with established hypertension, 102.4 +/- 26.6 g/m2 (mean +/- SD) v 93.6 +/- 23.5 (P = .045). Relative wall thickness was likewise significantly higher, 0.36 +/- 0.07 v 0.33 +/- 0.06 (P = .004). There was no significant difference in left atrial dimension. In a multiple regression model the ambulatory measurements and not the office measurements were statistically significantly associated with the extent of cardiac hypertrophy. Further, 44/53 (83%) of the patients with white coat hypertension had normal left ventricular dimensions, versus only 55/90 (61%) of the patients with established hypertension (P = .033). Thus, white coat hypertensive patients display less cardiac involvement than patients with established hypertension, indicating that they should rather be treated as normotensives than as hypertensives, ie, not with pharmacological antihypertensive therapy.

[What do we know about consultation hypertension?]. / Hvad ved vi om konsultationshypertension?

This review article examines the essential literature concerning "white coat" hypertension. It is stated that "white coat" hypertension is present in approximately 20% of patients with diagnosed mild to moderate hypertension. It is concluded that the pathophysiology of "white coat" hypertension is incompletely investigated; that the prognosis for untreated "white coat" hypertension seems fair; medical treatment being scarcely required. It is concluded further that more accurate diagnosis of mild to moderate hypertension, including the use of ambulatory blood pressure monitoring, will reduce the overall expenses by approximately million Danish crowns annually (approximately 2,000,000 pounds).

Habitual dislocation of the elbow.

Two cases of habitual dislocation of the elbow are presented, both of them in mentally deficient patients. Aetiology and operation methods are discussed and relevant literature reviewed.