Arterial stiffness: from isolated systolic hypertension to syncope

ESC CardioMed ◽  
2018 ◽  
pp. 2971-2976
Author(s):  
Jerzy Gąsowski ◽  
Chirag Bavishi ◽  
Franz H Messerli
Keyword(s):  
Blood Pressure ◽  
Pulse Pressure ◽  
Systolic Hypertension ◽  
Pulse Wave ◽  
Angiotensin Receptor Blockers ◽  
The Elderly ◽  
Channel Blockers ◽  
Isolated Systolic Hypertension ◽  
Converting Enzyme Inhibitors ◽  
European Guidelines

Isolated systolic hypertension (ISH) is the predominant form of hypertension in the elderly. The pathophysiology includes a plethora of factors; however, the stiffening of large arteries, leading to wider pulse pressure and faster propagation of the pressure pulse wave, are at the core of the disease. It has been shown that higher systolic blood pressure (SBP), pulse pressure, and pulse wave velocity are associated with a greater risk of cardiovascular complications, including a greater risk of dementia. In elderly patients, the relationship between SBP and the risk of mortality starts increasing at about 160 mmHg. A number of clinical trials were performed in populations of patients which included the elderly, however only four trials were specifically dedicated to answer the question of whether the active treatment of ISH (SHEP, Syst-Eur, Syst-China) or treatment of octogenarian hypertensive patients (HYVET) lowers cardiovascular risk in the elderly patient. They all showed that regimens based on thiazide-like diuretics, dihydropyridine calcium channel blockers, or angiotensin-converting enzyme inhibitors are capable of reducing the risk along with the appropriate reduction of SBP. This is widely reflected in the current European guidelines, with the addition of angiotensin receptor blockers. Nevertheless, the debate on the appropriate blood pressure goal is ongoing. However, none of the trials in the elderly had an average SBP lowered to less than 140 mmHg, and the overwhelming evidence suggests that in patients above the age of 70 with overt cardiovascular disease, a SBP less than 130 mmHg may be associated with an increase in risk.

Arterial hypertension + past stroke – a case report

2021 ◽  
Vol 14 (3) ◽  
pp. 324-326
Author(s):  
Maria Łukasiewicz ◽  
Marta Swarowska-Skuza
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Chronic Disease ◽  
Side Effects ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Systolic Hypertension ◽  
The Elderly ◽  
Isolated Systolic Hypertension ◽  
Special Group

Arterial hypertension, as a very widespread chronic disease, and thus differing in both pathomechanism and course in patients, requires a significant individualization of pharmacotherapy. One such special group is the elderly. Both the low-renin pathomechanism of arterial hypertension and its phenotype (isolated systolic hypertension) imply the choice of a specific pharmacotherapy. Additionally, in this group, side effects should be observed much more vigilantly, while target blood pressure values should be treated more liberally. An example of antihypertensive therapy in a patient belonging to the group described is presented in the following case.

scholarly journals Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 304-323 ◽  
Author(s):  
Hernando Vargas-Uricoechea ◽  
Manuel Felipe Cáceres-Acosta
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Angiotensin Receptor Blockers ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Patients With Diabetes ◽  
The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

scholarly journals Target Blood Pressure for Treatment of Isolated Systolic Hypertension in the Elderly

Hypertension ◽  
2010 ◽  
Vol 56 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Toshio Ogihara ◽  
Takao Saruta ◽  
Hiromi Rakugi ◽  
Hiroaki Matsuoka ◽  
Kazuaki Shimamoto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Hypertension ◽  
The Elderly ◽  
Target Blood Pressure ◽  
Isolated Systolic Hypertension

Associations of Blood Pressure with Functional and Cognitive Changes in Patients with Alzheimer's Disease

2016 ◽  
Vol 41 (5-6) ◽  
pp. 314-323 ◽  
Author(s):  
Fabricio Ferreira de Oliveira ◽  
Elizabeth Suchi Chen ◽  
Marilia Cardoso Smith ◽  
Paulo Henrique Ferreira Bertolucci
Keyword(s):  
Alzheimer’S Disease ◽  
Blood Pressure ◽  
Alzheimer's Disease ◽  
Rating Scale ◽  
Late Onset ◽  
Angiotensin Receptor Blockers ◽  
Channel Blockers ◽  
Clinical Dementia Rating ◽  
Cognitive Changes ◽  
Converting Enzyme Inhibitors

Background: Midlife hypertension followed by late life hypotension resulting from neurodegeneration increases amyloidogenesis and tauopathy. Methods: Consecutive outpatients with late-onset Alzheimer's disease (AD) at various stages and their respective caregivers were assessed for score variations in 1 year of tests assessing caregiver burden, functionality and cognition according to blood pressure (BP) variations and APOE haplotypes, while also taking into account differential effects of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, calcium channel blockers, diuretics, or no antihypertensive medication on score changes. The diagnosis and treatment of arterial hypertension followed the JNC 7 report. Results: Variations in systolic BP (-11.76 ± 17.1 mm Hg), diastolic BP (-4.92 ± 10.3 mm Hg) and pulse pressure (-6.84 ± 12.6 mm Hg) were significant after 1 year (n = 191; ρ < 0.01). For APOE4+ carriers, rises in systolic or diastolic BP improved Clinical Dementia Rating Scale Sum of Boxes scores (ρ < 0.04), with marginally significant improvements in Mini-Mental State Examination scores resulting from risen systolic (ρ = 0.069) or diastolic BP (ρ = 0.079), and in basic independence only regarding risen diastolic BP (ρ = 0.055). APOE4- carriers resisted any functional or cognitive effects of BP variations. No differences were found regarding any antihypertensive class for variations in BP or any test scores, regardless of APOE haplotypes. Conclusions: Targeting mild BP elevations brings better functional and cognitive results for APOE4+ carriers with AD.

scholarly journals The Prevalence and Risk Factors of Isolated Systolic Hypertension Among Elderly Chinese Population

2020 ◽  
Author(s):  
QingKun Zheng ◽  
Pengshun Rong ◽  
Xiaobo Huang ◽  
Yang Zhang ◽  
Jianxiong Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Physical Exercise ◽  
Chinese Population ◽  
Systolic Hypertension ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Cluster Sampling ◽  
Isolated Systolic Hypertension ◽  
Elderly Chinese

Abstract Objective To investigate the prevalence status of the isolated systolic hypertension (ISH) among the elderly Chinese population and analyze risk factors of ISH. Methods The survey was conducted from September 2015 to September 2016 enrolling 1269 people aging above 80 in the urban community in Chengdu, China. The participants were recruited by using a stratified cluster sampling method. The average blood pressure of an individual was obtained by using a standardized mercury sphygmomanometer to measure the blood pressure twice after a 10-minute seated rest. Results The prevalence of ISH was 53.0% among the elderly population; the ISH was accounted for 82.2% of all hypertension cases. The prevalence of ISH of males and females was 54.7% and 51.5%, respectively, without significant differences (P = 0.25). The prevalence of ISH in the 80–84 group, 85–89 group, and > 90 group were 52.5%, 53.0%, and 60.0%, respectively without significant differences (P for trend = 0.36). Multivariate logistic regression analysis showed that drinking alcoholic, obesity, and heart rate (HR) > 75 beats/min were all positively correlated to the incident of ISH; however, physical exercise was negatively correlated to the occurrence of ISH. Conclusion 53.0% of the elderly Chinese population aged above 80 has ISH. The gender and physical exercise are not the independent risk factor of ISH. But drinking alcoholic, obesity and HR > 75 are significantly related to the occurrence of ISH.

Abstract P482: Different Hemodynamic Phenotypes Of Isolated Systolic Hypertension In Adolescents

Hypertension ◽  
2017 ◽  
Vol 70 (suppl_1) ◽  
Author(s):  
Lukasz Obrycki ◽  
Anna Niemirska ◽  
Jedrzej Sarnecki ◽  
Zbigniew Kulaga ◽  
Mieczyslaw Litwin
Keyword(s):  
Blood Pressure ◽  
Pulse Pressure ◽  
Systolic Hypertension ◽  
Target Organ Damage ◽  
Intima Media Thickness ◽  
Left Ventricular ◽  
White Coat Hypertension ◽  
Control Group ◽  
Isolated Systolic Hypertension ◽  
Dominant Form

Objective: Isolated systolic hypertension (ISH) is a dominant form of primary hypertension (PH) in adolescents. Some of them present with normal central systolic blood pressure (cSBP), a phenomenon called spurious hypertension (sHT). The study was aimed to describe hemodynamics of PH in relation to cSBP, central pulse pressure (cPP) and target organ damage (TOD) in adolescents referred because of PH. Patients and Methods: In 267 children (59 girls; 14.9 ±2.6 years) referred with arterial hypertension, in whom secondary hypertension was excluded, 24 hour ABPM, left ventricular mass index (LVMi), carotid intima-media thickness (cIMT), pulse wave velocity (PWV), cSBP, cPP, cardiac index (CI) and stroke volume (SV) was assessed. 64 age and sex matched normotensive control children were control group. Results: 145 subjects had white coat hypertension (WCH) including 24 with ambulatory prehypertension (ambpreHT). Of 122 hypertensive pts, 39 had ambulatory hypertension (ambHT) and 83 severe ambulatory hypertension (severeHT). Normal cSBP was found in all WCH subject and 23 with ambpreHT. 39 of 122 (32%) hypertensive pts had sHT - 47.4% in those with ambHT and 26.5% with severeHT (p=0.0001). cIMT, LVMi, PWV, cSBP and cPP increased across blood pressure strata from normotension, through sHT to PH with elevated cSBP (all p<0.05). LVMi and cIMT correlated with cSBP (r = 0.220; p = 0.0007; r = 0.14; p = 0.04, respectively) and cPP (r = 0.274; p = 0.0001; r=0.202; p=0.002, respectively). 36 pts with left ventricular hypertrophy (LVH) had greater cPP (52 ±10 mmHg) in comparison with subjects without LVH (47 ±8 mmHg; p = 0.027). Regression analysis revealed cPP as the only predictor of LVMi (r 2 = 0.09, β = 0.143, p = 0.03). ROC area for predictors of LVH revealed similar area under curve for cSBP (0.585), cPP (0.618) and 24h systolic ABPM (0.612). Patients with sHT had greater amplification of pulse pressure than normotensive ones. CI and SV was lowest in normotensive controls, intermediate in sHT patients and highest in patients with elevated cSBP (p<0.05). Conclusions: sHT present with intermediate hemodynamic phenotype between normotension and sustained PH. cSBP and cPP differentiates patients with severeHT and TOD from patients with WCH, ambpreHT and ambHT without TOD

scholarly journals PREVALENCE OF HYPERTENSION AMONG ELDERLY RESIDING IN SLUMS OF WEST

2018 ◽  
Vol 11 (4) ◽  
pp. 337
Author(s):  
Zaozianlungliu Gonmei ◽  
Supriya Dwivedi ◽  
Gurudayal Singh Toteja ◽  
Karuna Singh ◽  
Naval Kishore Vikram
Keyword(s):  
Blood Pressure ◽  
Systolic Hypertension ◽  
Elderly Population ◽  
Lifestyle Modification ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Isolated Systolic Hypertension ◽  
Health Checkup ◽  
Cross Sectional

 Objective: The present study was carried out to assess the prevalence of hypertension among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 202 elderly residing in urban slums of West Delhi. Hypertension was classified as per JNC VII criteria. Blood pressure was measured twice using digital machine (OMRON) after an interval of 5 min. The data obtained were analyzed for percent prevalence, mean, standard deviation, and median.Results: The overall prevalence of hypertension was 49.1%; higher among male (56.0%) than female (41.9%). The prevalence of Stage I, Stage II, and isolated systolic hypertension was 30.7%, 18.8%, and 47%, respectively.Conclusion: Almost half of the elderly population in slums was hypertensive. Periodical health checkup and management through treatment and dietary and lifestyle modification is needed. 

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