Treating Isolated Systolic Hypertension in the Elderly

OBJECTIVE: To review the prevalence, pathophysiology, vascular risk, and treatment of isolated systolic hypertension (ISH) in the elderly. DATA SOURCE: A MEDLINE search of the English language literature was performed to identify pertinent literature. Key search terms were hypertension, systolic, and elderly. STUDY SELECTION: All studies available evaluating drug therapy for ISH or hypertension in the elderly as well as review articles discussing the prevalence, pathophysiology, and treatment of ISH were selected. SYNTHESIS: ISH occurs commonly in the elderly and is associated with increased risk for cardiovascular and cerebrovascular disease. Although the mechanism for ISH in the elderly is not completely understood, the primary factor is believed to be a reduction in arterial compliance. Results of the Systolic Hypertension in the Elderly Program demonstrated that control of ISH using a diuretic alone or in combination with a beta-blocker significantly reduced the incidence of strokes and cardiovascular events. In this trial, drug therapy was found to be safe and generally well tolerated by the elderly. Newer antihypertensive agents such as the calcium-channel blockers and angiotensin-converting enzyme (ACE) inhibitors have also been shown to effectively lower SBP in the elderly, but the effects on long-term morbidity and mortality are not yet known. CONCLUSIONS: ISH is an important risk factor for vascular disease in the elderly. Accurate diagnosis and effective drug treatment can result in significant reductions in the risk of cardiovascular and cerebrovascular events. Based on the available trial data, diuretics appear to be the drugs of first choice unless there are contraindications. If combination drug therapy is required, beta-blockers should be considered although their contribution to vascular risk reduction remains less clear. Additional studies are needed to determine the long-term benefits and risks of alternative antihypertensive agents such as calcium-channel blockers and ACE inhibitors.

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Antiproteinuric effects of antihypertensive agents in non-diabetic hypertensive population

Open Medicine ◽

10.2478/s11536-008-0036-8 ◽

2008 ◽

Vol 3 (3) ◽

pp. 287-293

Author(s):

Zorica Jovic ◽

Vidojko Djordjevic ◽

Karin Vasic ◽

Snezana Cekic ◽

Jankovic Irena

Keyword(s):

Blood Pressure ◽

Calcium Channel ◽

Antihypertensive Drug ◽

Calcium Channel Blockers ◽

Ace Inhibitors ◽

Statistical Significance ◽

Antihypertensive Agents ◽

Channel Blockers ◽

Significant Difference ◽

Change In Mean

AbstractArterial hypertension and proteinuria are important factors associated with the progression of both diabetic and nondiabetic chronic kidney disease. The objective of the present study was to determine the influence of different antihypertensive drug groups on urinary albumin excretion (UAE) as related to blood pressure in non-diabetic population. Subjects (n=39) with chronic renal disease accompanied by mild to moderate hypertension and varying degrees of proteinuria were divided into 3 groups based on UAE values and placed on nonpharmacological and/or treatment with an antihypertensive drug regimen (consisting of one or more antihypertensive drugs [beta blocker, ACE inhibitor or calcium-channel blocker]) to achieve a target blood pressure ≤ 130/85 mmHg. Periodic UAE measurements were performed. A reduction was observed over time in most patients, however, it reached statistical significance only in the microalbuminuric group (P<0.01). Patients were further stratified into 5 groups depending on assigned therapy: 0, nonpharmacological treatment; 1-drug group 1; 12-drug groups 1 and 2; 13-drug groups 1 and 3; 123-all 3 drug groups (1-ACE inhibitors, 2-beta blockers, 3-calcium channel blockers). A statistically significant change in mean UAE values at the start and end of the study period in patients assigned to drug groups 12, 13, and 123 was achieved (P < 0.05). Also, there was a statistically significant difference in the average reduction of proteinuria under varying antihypertensive drug regimens (P < 0.05). In conclusion, in patients with hypertension, changes in UAE depend on initial UAE values and administered antihypertensive treatment. ACE inhibitors combined with calcium channel blockers resulted in a higher UAE reduction than other drug groups.

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Major cardiovascular events in long-term treated essential hypertensive patients: calcium channel blockers (CCB) versus ACE inhibitors (ACEI)

American Journal of Hypertension ◽

10.1016/s0895-7061(99)80041-7 ◽

1999 ◽

Vol 12 (4) ◽

pp. 11 ◽

Cited By ~ 1

Author(s):

C CAMPO

Keyword(s):

Calcium Channel ◽

Calcium Channel Blockers ◽

Ace Inhibitors ◽

Cardiovascular Events ◽

Channel Blockers ◽

Hypertensive Patients ◽

Major Cardiovascular Events

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Impact of antihypertensive therapy on the functional state of the pituitary-gonadal system in patients with arterial hypertension

Arterial’naya Gipertenziya (Arterial Hypertension) ◽

10.18705/1607-419x-2005-11-1-34-38 ◽

2005 ◽

Vol 11 (1) ◽

pp. 34-38 ◽

Cited By ~ 1

Author(s):

N. V. Ivanov

Keyword(s):

Arterial Hypertension ◽

Calcium Channel ◽

Antihypertensive Therapy ◽

Calcium Channel Blockers ◽

Ace Inhibitors ◽

Antihypertensive Agents ◽

Free Testosterone ◽

Blood Levels ◽

Channel Blockers ◽

The Impact

The aim of the study was to evaluate the impact of antihypertensive therapy with slow calcium-channel blockers, angiotensin-converting enzyme (ACE) inhibitors, and ß-adrenergic receptor blockers on the metabolism and blood levels of major adrenal androgens and gonads, as well as the insulin resistance in males with arterial hypertension (AH) Ninety-one patients with AH and 15 age-matched healthy male controls were examined The hypertensive males treated with slow calcium-channel blockers or ACE inhibitors were found to have a lower level of insulin and higher levels of dehydroepiandrosterone sulfate and free testosterone on the 30th day of treatment Those on blockers were observed to have a higher level of insulin and lower levels of major adrenal and testicular androgens as compared with their baseline levels Therapy did not alter the levels of gonadotropic hormones, estradiol, and cortisol and they did not differ in the compared groups The family history of AH has a modulating effect on a hormonal response in males with AH treated with antihypertensive agents

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Arterial stiffness: from isolated systolic hypertension to syncope

ESC CardioMed ◽

10.1093/med/9780198784906.003.0718 ◽

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.

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Stroke Prevention: Not all Antihypertensive Drugs are Created Equal

Journal of the Renin-Angiotensin-Aldosterone System ◽

10.1177/14703203050060010201 ◽

2005 ◽

Vol 6 (1_suppl) ◽

pp. S4-S7 ◽

Cited By ~ 1

Author(s):

Franz H Messerli ◽

Simbo M Chiadika

Keyword(s):

Calcium Channel ◽

Calcium Channel Blockers ◽

Ace Inhibitors ◽

Beta Blockers ◽

Angiotensin Receptor Blockers ◽

Antihypertensive Agents ◽

Channel Blockers ◽

At2 Receptor ◽

Angiotensin Receptor ◽

Receptor Blockers

Reductions in blood pressure (BP) through intervention can significantly reduce the risk of cardiovascular events in hypertensive patients. However, a number of trials indicate that beta-blockers, despite lowering BP, do not reduce the risk of stroke. A recent meta-analysis suggested that, over and beyond BP reduction, angiotensin-converting enzyme (ACE) inhibitors appear superior to calcium channel blockers for prevention of coronary heart disease whereas calcium channel blockers appear superior to ACE inhibitors for prevention of stroke. Indeed, in the Syst-EUR study a 42% reduction in strokes was achieved in the calcium antagonist arm when compared to the placebo arm.It is hypothesised that antihypertensive agents that stimulate the AT2-receptor (thiazide diuretics, dihydropyridine calcium antagonists and angiotensin receptor blockers) are more cerebroprotective than drug classes that do not stimulate the AT2-receptor (beta-blockers and ACE inhibitors).The angiotensin receptor blockers are the only drug class that have a dual mechanism of action that could be helpful in preventing strokes in that they not only inhibit the AT1-receptor but also allow stimulation of the AT2-receptor. Not surprisingly therefore, in trials such as LIFE, VALUE and MOSES, angiotensin receptor blockers showed excellent cerebroprotection.

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