scholarly journals Antihypertensive Treatment in the Elderly and Very Elderly: Always “the Lower, the Better?”

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Alberto Mazza ◽  
Emilio Ramazzina ◽  
Stefano Cuppini ◽  
Michela Armigliato ◽  
Laura Schiavon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trials ◽  
Antihypertensive Treatment ◽  
Antihypertensive Drugs ◽  
The Elderly ◽  
Organ Damage ◽  
Very Elderly ◽  
Age Dependent ◽  
Prolongation Of Life ◽  
Per Se

Arterial hypertension (HT) is age dependent and, with the prolongation of life expectancy, affects more and more elderly people. In the elderly, HT is a risk factor for organ damage and cardiovascular (CV) events. Both pharmacologic and nonpharmacologic reduction of blood pressure (BP) is associated with a corresponding decrease in systolic-diastolic or isolated systolic HT. Clinical trials have shown that BP lowering is associated with a decrease in stroke and other CV events. Therefore, BP reductionper seappears more important than a particular class of antihypertensive drugs. The benefit of antihypertensive treatment has been confirmed up to the age of 80 years, remaining unclear in the octogenarians. The benefit in lowering diastolic BP between 80 and 90 mmHg is well established, while that of lowering systolic BP below 140 mmHg requires further confirmations.

scholarly journals Hypertension in the elderly

2012 ◽  
Author(s):  
Giuliano Pinna ◽  
Claudio Pascale ◽  
Micaela La Regina ◽  
Francesco Orlandini
Keyword(s):  
Blood Pressure ◽  
Healthy Lifestyle ◽  
The Elderly ◽  
Consensus Conference ◽  
Lifestyle Changes ◽  
Isolated Systolic Hypertension ◽  
Very Elderly ◽  
Pharmaceutical Therapy ◽  
High Prevalence ◽  
Treatment Of Hypertension

IntroductionThere is a high prevalence of hypertension in the elderly, as evidenced by clinical and health behavioral policies. Still, there are uncertainties on the treatment of hypertension, especially treatment of the very elderly. These considerations have largely been ignored in clinical trials due to concern regarding contamination by other pathologies that are difficult to frame and manage.Methods We performed an effective and ample literature review and provided reflections on the Consensus Conference ACCF/AHA 2011 on the principle types of hypertension found in the elderly. We also considered the associated principle pathologies for various treatments and related organs.Discussion Even if the goal of treatment of elevated blood pressure in the elderly is same as in younger population, it is no longer certain that a target systolic blood pressure (SBP) <140 mmHg should be persistently reached in the very elderly. It is important to note that for all studies these values have never been reached. In the treatment of isolated systolic hypertension (ISH) the preferred target is a SBP >160 mmHg. Treating hypertension in the elderly and very elderly reduces the risk of stroke and heart failure, though the evidence is inconclusive for all-cause mortality.Conclusion Hypertension in the elderly is very common and needs to be treated with criteria that consider the patient's age, comorbidities, lifestyle and adherence. Above all, in the very elderly, therapeutic treatment should be personalized according to the above criteria. Where possible pharmaceutical therapy should be limited at the preference of healthy lifestyle changes (physical activity, diet, etc.).

scholarly journals New targets and old therapies for arterial hypertension

2019 ◽  
pp. 46-52
Author(s):  
S. R. Gilyarevsky ◽  
N. G. Bendeliani ◽  
M. V. Golshmid ◽  
G. Yu. Zakharova ◽  
I. M. Kuzmina ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Arterial Hypertension ◽  
Randomized Clinical Trials ◽  
Antihypertensive Drugs ◽  
Experimental Studies ◽  
The Elderly ◽  
Published Data ◽  
Efficacy And Safety ◽  
Adoption And Implementation ◽  
Moderate Cognitive Impairment

The article discusses approaches to the choice of antihypertensive drugs, which may be based on the adoption and implementation of new clinical guidelines for the management of patients with arterial hypertension. This paper provides data on the efficacy and safety of candesartan, an antihypertensive drug, which advantages were identified during a large number of randomized clinical trials. It discusses the recently published data on the effectiveness of more intensive regimens of antihypertensive therapy to reduce the risk of moderate cognitive impairment in patients with arterial hypertension. In this regard, the authors provide data of the previously completed studies, which showed the effect of candesartan on the rate of cognitive decline in patients with arterial hypertension in the elderly and senile age. The features of the pharmacological characteristics of candesaratan that can remotely explain its clinical efficacy are considered. The data of experimental studies of candesartan in animals, which contribute to the concept of the possible effects of candesartan, are presented.

scholarly journals Empagliflozin for Patients With Presumed Resistant Hypertension: A Post Hoc Analysis of the EMPA-REG OUTCOME Trial

2020 ◽  
Author(s):  
João Pedro Ferreira ◽  
David Fitchett ◽  
Anne Pernille Ofstad ◽  
Bettina Johanna Kraus ◽  
Christoph Wanner ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Resistant Hypertension ◽  
Repeated Measures ◽  
Cox Regression ◽  
Antihypertensive Drugs ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Cardiac Events ◽  
Post Hoc Analysis ◽  
Post Hoc

Abstract BACKGROUND Type 2 diabetes (T2D) and resistant hypertension often coexist, greatly increasing risk of target-organ damage and death. We explored the effects of empagliflozin in patients with and without presumed resistant hypertension (prHT) in a post hoc analysis of EMPA-REG OUTCOME (NCT01131676). METHODS Overall, 7,020 patients received empagliflozin 10, 25 mg, or placebo with median follow-up of 3.1 years. We defined baseline prHT as ≥3 classes of antihypertensive drugs including a diuretic and uncontrolled blood pressure (BP; systolic blood pressure (SBP) ≥140 and/or diastolic blood pressure ≥90 mm Hg) or ≥4 classes of antihypertensive, including a diuretic, and controlled BP. We explored the effect of empagliflozin on cardiovascular (CV) death, heart failure (HF) hospitalization, 3-point major adverse cardiac events, all-cause death, and incident/worsening nephropathy by Cox regression and BP over time by a mixed-repeated-measures-model analysis. RESULTS 1,579 (22.5%) patients had prHT. The mean difference in change in SBP from baseline to week 12 vs. placebo was −4.5 (95% confidence interval, −5.9 to −3.1) mm Hg (P &lt; 0.001) in prHT and −3.7 (−4.5, −2.9) mm Hg (P &lt; 0.001) in patients without prHT. SBP was more frequently controlled (&lt;130/80 mm Hg) with empagliflozin than with placebo. Patients with prHT had 1.5- to 2-fold greater risk of HF hospitalization, incident/worsening nephropathy, and CV death compared with those without prHT. Empagliflozin improved all outcomes in patients with and without prHT (interaction P &gt; 0.1 for all outcomes). CONCLUSIONS Empagliflozin induced a clinically relevant reduction in SBP and consistently improved all outcomes regardless of prHT status. Due to these dual effects, empagliflozin should be considered for patients with hypertension and T2D.

Nocturnal hypotension and blood pressure variability in the elderly: the effects of antihypertensive treatment

1989 ◽  
Vol 7 (11) ◽  
pp. 930-931
Author(s):  
S G Jyothinagaram ◽  
D M Watson ◽  
I M McGinley ◽  
F Nicol ◽  
P L Padfield
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Variability ◽  
Antihypertensive Treatment ◽  
The Elderly

scholarly journals An 8-year-old boy with renal artery stenosis and cerebral infarct

1970 ◽  
Vol 5 (1) ◽  
pp. 32-33
Author(s):  
Syed Dawood Md Taimur ◽  
Tamzeed Ahmed ◽  
Md Golam Muinuddin ◽  
Salma Jahan ◽  
Farzana Islam
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Antihypertensive Drugs ◽  
Organ Damage ◽  
Secondary Hypertension ◽  
Cerebral Infarct ◽  
Artery Stenosis ◽  
Short Period ◽  
Hypertension In Children

Secondary hypertension is more common in children compared to that in adults, leading to organ damage and increased mortality. Renal artery stenosis could be a sequel to secondary hypertension in children and give rise to serious outcomes. A case of renal artery stenosis in an eight year old boy is presented in this study in whom PTA was performed with successful results. Blood pressure was controlled and all antihypertensive drugs could be withdrawn in a short period of time.Ibrahim Med. Coll. J. 2011; 5(1): 32-33 Indexing words: Secondary hypertension; children; renal artery stenosis; surgery.DOI: http://dx.doi.org/10.3329/imcj.v5i1.9862

Developments in Strategies for Treating High-risk Hypertension

2009 ◽  
Vol 5 (1) ◽  
pp. 56
Author(s):  
Cristina Sierra ◽  
Antonio Coca ◽  
◽  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Antihypertensive Drugs ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Current Evidence ◽  
Global Risk ◽  
Raas Blockade

On the basis of current evidence provided by various studies, the most recent international guidelines recommend reducing blood pressure levels to below 140/90mmHg for all hypertensive patients over 18 years of age, including the elderly, when this is clinically tolerated, as a necessary measure to reduce the global cardiovascular risk, which is the fundamental objective of treatment. For high-risk hypertensives, such as patients with diabetes, patients with silent target organ damage or established clinical cardiovascular disease, levels below 130/80mmHg should be reached and maintained, with even lower levels for patients with established renal disease and proteinuria within the nephrotic range. Blood pressure control in high-risk patients should be achieved as rapidly as possible using initial strategies that include combinations of antihypertensive drugs, and also the best drugs and drug combinations with proven capacity to regress silent organ damage and to interrupt the progression of cardiovascular disease. This must be accompanied by the additional lifestyle measures and drugs necessary to control other associated cardiovascular risk factors. In clinical practice this means that, together with renin–angiotensin–aldosterone system (RAAS) blockade, often associated with calcium-channel blockade, statins and antiplatelet drugs should routinely be administered in most patients, particularly those over 55 years of age, as they provide the only possibility of global risk prevention leading to greater survival.

scholarly journals Associations between Ambulatory Blood Pressure Parameters and Cerebral White Matter Lesions

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Cristina Sierra
Keyword(s):  
Blood Pressure ◽  
White Matter ◽  
Ambulatory Blood Pressure ◽  
Blood Pressure Monitoring ◽  
White Matter Lesions ◽  
The Elderly ◽  
Organ Damage ◽  
Common Finding ◽  
Cerebral White Matter ◽  
Cerebral White Matter Lesions

Silent cerebral white matter lesions (WMLs) are a common finding on magnetic resonance imaging of the brain in the elderly. However, in patients with hypertension, WMLs tend to occur earlier in life and appear to be more severe. There is a body of evidence that supports the idea that WMLs in asymptomatic hypertensive patients should be considered a silent early marker of brain damage. It is known that ambulatory blood pressure monitoring (ABPM) correlates more closely with hypertension-related organ damage than office blood pressure. This paper focuses on the associations between blood pressure parameters obtained by 24-hour ABMP and cerebral WMLs.

scholarly journals Fixed-Dose Triple Combination of Antihypertensive Drugs Improves Blood Pressure Control: From Clinical Trials to Clinical Practice

2017 ◽  
Vol 34 (4) ◽  
pp. 975-985 ◽  
Author(s):  
Alberto Mazza ◽  
Salvatore Lenti ◽  
Laura Schiavon ◽  
Antonella Paola Sacco ◽  
Fabio Dell’Avvocata ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Blood Pressure Control ◽  
Antihypertensive Drugs ◽  
Pressure Control ◽  
Fixed Dose ◽  
Triple Combination
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