Distinguishing Lewy body dementia.

The presence of the distinctive formations known as Lewy bodies within brain cells has been linked to senile dementia. A pattern of clinical features helps distinguish Lewy body dementia from Alzheimer's and Parkinson's diseases. Differentiation can be important, because many patients with Lewy body dementia have a hypersensitivity to neuroleptic medications.

Hypertension in the elderly.

A systolic blood pressure greater than 160 mm Hg is a more significant risk factor for cardiovascular disease than a diastolic blood pressure greater than 95 mm Hg, regardless of a patient's age. Treatment of isolated systolic hypertension significantly reduces the incidence of both fatal and nonfatal cardiovascular events, even in patients who are over 80 years of age. Non-pharmacologic measures and behavior modification should be tried for three to six months in a patient with mildly elevated blood pressure (140 to 160 mm Hg/90 to 100 mm Hg). If these measures fail or the patient has target-organ disease or multiple cardiac risk factors, medication may be prescribed earlier. Half the usual recommended dose should be initially prescribed in the frail elderly. Long-acting diuretics or beta blockers are recommended first-line agents. Angiotensin-converting enzyme inhibitors, calcium channel blockers and alpha blockers have not been shown to reduce mortality in hypertensive patients who do not have comorbid disease. Angiotensin-converting enzyme inhibitors may benefit hypertensive patients with heart failure, and calcium channel blockers may help those with angina, especially vasospastic angina.

Safety and efficacy of metoprolol in the treatment of hypertension in the elderly.

OBJECTIVE: To assess the short-term efficacy and safety of metoprolol in the treatment of hypertension in a large population of older patients. DESIGN: Prospective, open-label surveillance study. SETTING: Multicenter outpatient offices. PARTICIPANTS: 21,692 patients with mild-to-moderate hypertension between the ages of 50 to 75 years. Patients were excluded if they had a contraindication to beta-blocker therapy. INTERVENTION: Patients were treated with 100 mg of metoprolol once daily for 4 week. If the blood pressure was controlled, therapy was continued for an additional 4 weeks. If adequate blood pressure was not achieved after 4 weeks, 25 mg of hydrochlorothiazide was added. At the end of 8 weeks, final therapy decisions were recorded. If the blood pressure was controlled, therapy was continued for an additional 4 weeks. MAIN OUTCOME MEASURES: Blood pressure, heart rate and side-effects. RESULTS: After 4 weeks of therapy, mean systolic and diastolic blood pressures decreased significantly from 162/95 to 148/87 mm Hg (P less than 0.001). Fifty-eight percent of the patients had satisfactory blood pressure control. At the end of 8 weeks, mean systolic and diastolic blood pressure decreased to 143/84 mm Hg. Blood pressure response was similar in all age groups. At the termination of the study, 50% of the patients were continued on monotherapy, and 27% were continued on combined therapy. Overall, there was less than a 5% incidence of medical problems, and excellent or good tolerability was noted for 94% of the patients. CONCLUSIONS: Metoprolol administered as monotherapy or in combination with hydrochlorothiazide was effective in normalizing blood pressure in a majority of elderly hypertensive patients. Both drug regimens were well tolerated.

The Safety After Fifty Evaluation trial: evaluation of the safety and efficacy of antihypertensive therapy with metoprolol in patients 50 to 75 years of age: study design.

Hypertension increases in prevalence with advancing age and is a major risk factor for the development of cardiovascular disease in elderly patients. However, the presence of coexisting illness, altered drug metabolism, enhanced susceptibility to drug side effects, and physiologic changes such as reduced plasma volume and lower plasma renin levels make treatment of hypertension in elderly patients more difficult. Nonetheless, several studies have now demonstrated the beneficial effects of antihypertensive drug therapy in older patients. The Safety After Fifty Evaluation trial was designed to determine the short-term efficacy and tolerability of once-daily therapy with the cardioselective beta-blocker metoprolol alone or in combination with hydrochlorothiazide in the treatment of mild hypertension in patients 50 to 75 years of age. A total of 24,816 patients were enrolled in the trial by 2821 practicing physicians from across the United States. This article describes the details of the Safety After Fifty Evaluation study design. Results of the trial will be reported separately.