The incidence of hypertension increases with age. Although there is ample evidence regarding the benefit of treating elderly hypertensive patients, resulting in decreases in cardiovascular morbidity and mortality, the adverse effects of treatment are also frequently reported in these often frail individuals. Therefore, it is difficult to determine the level to which blood pressure should be decreased and what type of antihypertensive medication is most effective and best tolerated. The approach to treating hypertension in octogenarians at the Cleveland Clinic Florida was reviewed. An analysis of 100 consecutive charts of hypertensive octogenarians treated by internists from January 1, 1993, with a minimum of 1 year follow up, was carried out. The mean age of the population studied was 84.7 years (range, 80-97Â+/-4.13 years). The mean initial blood pressure was 152/83 mm Hg, and the mean final blood pressure was 145/76 mm Hg (pless than 0.01). The initial number of medications used was 1.2, which rose to 1.6 by the final reading (pless than 0.0001). The most frequently used drug classes were calcium channel blockers, followed by diuretics and ACE inhibitors. Most of the octogenarians tolerated their antihypertensive medication well. (c)2000 by Le Jacq Communications, Inc.

The rise in systolic blood pressure and the increasing risk of isolated systolic hypertension with advancing age have been attributed, in part, to increased peripheral vascular resistance. Available evidence also suggests that at any given level of arterial pressure, overweight patients with hypertension have a higher cardiac output and a lower total peripheral vascular resistance than lean patients. The lower peripheral resistance associated with overweight patients may attenuate the rise in systolic blood pressure and modify the prevalence of isolated systolic hypertension with age. Using data from the third National Health and Nutrition Examination Survey we examined the relationship between body weight and the age-related rise in systolic blood pressure, and determined the implication of this relationship for the prevalence of isolated systolic hypertension in the older adult population. The age-related rise in systolic blood pressure and the prevalence of isolated systolic hypertension were higher among the lean than in the overweight (odds ratio 1.29 and p value 0.039). The prevalence of isolated systolic hypertension increased by 56% from 6.2% in the fourth to 9.7% in the first body mass index quartile. Among the overweight subjects the prevalence of isolated systolic hypertension continued to decrease until the body mass index exceeded 31.6. OBJECTIVE: To examine the relationship between body weight and the age-related rise in systolic blood pressure, and determine the implication of this relationship for the prevalence of isolated systolic hypertension in the older adult population. DESIGN: A cross-sectional study. SETTING: The study began with a 1-hour home visit for a household interview and ended a few weeks later with a 4-hour physical examination at a mobile examination center. PARTICIPANTS: A sample of the civilian, non-institutionalized population of the U.S. MAIN OUTCOME MEASURES: Age-related rise in systolic blood pressure and the prevalence of isolated systolic hypertension. RESULTS: The age-related rise in systolic blood pressure and the prevalence of isolated systolic hypertension were higher among the lean than in the overweight. The prevalence of isolated systolic hypertension decreased with increased body mass index of 31.6. Systolic blood pressures increased in obese than nonobese subjects. CONCLUSIONS: Body mass index less than 25 is associated with an increase in the age-related rise in systolic blood pressure and the prevalence of isolated systolic hypertension in the older population. (c)2000 by Le Jacq Communications, Inc.

Reliability and reproducibility of an automatic ambulatory blood pressure recorder (ICR-5200, Squibb) were tested on 45 subjects (24 normotensives and 21 hypertensives) aged 32-64 (mean age 49). Of 6,566 recordings, 2,376 measurements were cross-checked with a Riva Rocci sphygmomanometer in supine, standing, or sitting position at the beginning and at the end of a 24-hour monitoring period. Moreover, in 11 normotensives and in 11 hypertensives, cross-checking was performed during a cycloergometer effort test. A highly significant linear correlation was found in all the conditions tested (r = 0.98, p less than 0.001 for systolic and r = 0.98, p less than 0.001 for diastolic pressure) either in hypertensives or in normotensives. Only 8% of diastolic measurements performed by the two methods differed more than 5 mmHg. For each subject 5.4 +/- 3.8% of the preprogrammed measurements were lost. Only seven out of 45 subjects referred a disturbed sleep. ICR-5200 seems a suitable and reliable tool for automatic blood-pressure recording.

The current study investigated hostile mood, response style (repression-sensitization [RS]), and cardiovascular (blood pressure and heart rate) as well as endocrine recovery (cortisol, norepinephrine, and epinephrine) from a 10-minute mental task in 57 healthy, adult women. Emphasis was placed on resting levels and recovery from, rather than the more frequently studied initial responses to, mental stress tasks. The task consisted of the "Electrocardiogram Quiz" (shortened version) and mental arithmetic (serial subtraction) of equal length, totaling 10 minutes. Physiological/biochemical samples were collected at the end of a 15-minute adaptation phase (i.e., the designated baseline), at the end of the mental task phase and at 5-minute and 30-minute recovery. R-S and hostility scale scores were not correlated and permitted the creation of four subsamples: 1) repressor-low expressed hostility; 2) repressor-high expressed hostility; 3) sensitizer-low expressed hostility; and 4) sensitizer-high expressed hostility. Results indicated that tonic levels of SBP and DBP were consistently higher in subjects with low expressed hostility. Cortisol level and phasic activity discriminated between high expressed hostility-sensitizers and the other three samples, with the former displaying more cortisol activity at baseline and at 30-minute recovery. Women on birth control pills had consistently elevated levels of cortisol secretion throughout.

The renin-angiotensin system may effect blood pressure regulation by enhancing sympathetic activity. Angiotensin II given in subpressor doses has been shown to enhance the vasoconstrictive effect of norepinephrine in several animal models. However, the effects of subpressor doses of angiotensin II on the vasoconstrictor effects of norepinephrine have not been reported in humans. We found that angiotensin II, given in subpressor doses, potentiates the vascular response of norepinephrine in normotensive and hypertensive male subjects. These results demonstrate the important inter-relationship of the renin-angiotensin system to the sympathetic nervous system in normal and essential hypertensive man.

Stress tests are commonly used for an evaluation of blood pressure reactivity, but few data exist in the literature about interindividual variability and intraindividual medium-term reproducibility of blood pressure responses to these tests in borderline hypertension. To this aim we have studied 20 borderline hypertensive patients (age range, 33-59, mean 45). Our data suggest that borderline hypertensive patients cannot be considered a homogeneous group with regard to blood pressure reactivity because they tend to have widely different blood pressure responses to various stress tests. For each test (except for orthostatic stimulation), a fairly good intraindividual reproducibility was found. Considering the poor correlations existing between blood pressure responses to tests for each patient, one test may not be sufficient to characterize blood pressure reactivity to stress in borderline hypertension.

We have compared hypertensive target organ damage with home blood pressure readings (HBPs) and with office blood pressure readings (OBPs) in 100 patients with mild to moderate essential hypertension. The correlation between blood pressure levels and hypertensive target organ damage in HBPs and OBPs were similar (r = .42, p less than 0.001 for systolic HBPs; r = .33, p less than 0.001 for diastolic HBPs; r = .42, p less than 0.001 for systolic OBPs; r = .34, p less than 0.001 for diastolic OBPs). In most instances, HBPs were lower than corresponding OBPs. Among individual patients whose OBPs were identical, HBPs in some instances differed strikingly. Optic fundi abnormalities were significantly more severe in patients whose systolic HBPs were 150 mmHg or greater, than in those whose systolic HBPs were less than 150 mmHg (p less than 0.05). Hypertensive complications did not differ among office hypertensive patients who were normotensive or borderline hypertensive at home, from the differences of OBPs. We concluded that overall hypertensive complications were equally related to HBPs and OBPs, but patients with discrepancies between HBPs and OBPs had fewer hypertensive complications. Thus, both OBPs and HBPs should be considered in deciding therapy.

Although dissimilar in chemical structure and pharmacokinetics, the two available angiotensin-converting enzyme inhibitors captopril and enalapril have proved to be comparably effective in controlling essential and renal forms of hypertension in studies of once and twice daily dosing. Abundant data from controlled clinical trials and worldwide experience, particularly for captopril, indicate the safety and absence of subjective side effects when used alone in relatively low dosage or in combination with a diuretic.