Blood pressure lowering for the primary and secondary prevention of stroke: treatment of hypertension reduces the risk of stroke.

Hypertension is the most important risk factor in the development of stroke. It is also the risk factor most amenable to treatment. The results from 18 controlled trials show a reduction in relative risk of stroke of 25-47% among treated hypertensive patients. This reduction applies both to the elderly and to younger patients, but the absolute reductions are greater among the elderly and the number of patients with hypertension that need to be treated to prevent a stroke is lower in the elderly because they have a higher risk of stroke. The reductions in relative but not absolute risk appear to be similar for both isolated systolic hypertension and combined systolic and diastolic hypertension in the elderly. The case for antihypertensive treatment in the secondary prevention of stroke is less clear but the results of four clinical trials of antihypertensive treatment among patients with and without hypertension and a history of cerebrovascular disease point to a probable benefit. The results of the PROGRESS trial will elucidate this further.     

老年糖尿病患者合并高血压的危险因素及随访分析

目的探讨老年糖尿病患者合并高血压的患病率、危险因素及随访分析。方法选择开滦集团退休职工健康体检者26 074例,根据诊断分为糖尿病组3658例和无糖尿病组22 416例。分析糖尿病患者高血压患病率、危险因素及靶器官损害。随访5年,记录糖尿病患者心肌梗死、脑卒中及心血管死亡等事件的发生,无高血压患者高血压的累计发病率及危险因素。结果糖尿病组高血压患病率明显高于无糖尿病组(70.5%vs 60.2%,P<0.01)。吸烟、打鼾、肥胖、高TG血症、高LDL-C血症为老年糖尿病合并高血压的危险因素(P<0.05,P<0.01)。随访5年,老年糖尿病合并高血压患者脑卒中发生率明显高于无高血压患者(6.4%vs 4.6%,P<0.05)。老年糖尿病无高血压患者高血压累计发病率为40.1%。肥胖、高LDL-C血症是老年糖尿病患者随访5年发生高血压的2个主要危险因素(P<0.01)。结论老年糖尿病患者高血压患病率显著增加,常合并心肌梗死、脑卒中、肾脏功能不全等靶器官损害,更容易发生脑卒中。     

J-shaped relation between blood pressure and stroke in treated hypertensives

The objective of this study was to investigate the relationship between hypertension and risk of stroke in the elderly. The study was performed within the framework of the Rotterdam Study, a prospective population-based cohort study. The risk of first-ever stroke was associated with hypertension (relative risk, 1.6; 95% CI, 1.2 to 2.0) and with isolated systolic hypertension (relative risk, 1.7; 95% CI, 1.1 to 2.6). We found a continuous increase in stroke incidence with increasing blood pressure in nontreated subjects. In treated subjects, we found a J-shaped relation between blood pressure and the risk of stroke. In the lowest category of diastolic blood pressure, the increase of stroke risk was statistically significant compared with the reference category. Hypertension and isolated systolic hypertension are strong risk factors for stroke in the elderly. The increased stroke risk in the lowest stratum of blood pressure in treated hypertensive patients may indicate that the therapeutic goal of "the lower the better" is not the optimal strategy in the elderly.     

Quality of life and the treatment of hypertension in the elderly

A recent dramatic increase in the number of elderly patients with hypertension has made the proper management of the disease in this population more important. Since quality of life (QOL) is greatly affected in elderly patients with hypertension, as a life-style disease, we reviewed QOL and related issues in the treatment of hypertension in the elderly. Assessment of QOL requires multi-dimensional evaluation from many aspects. Elderly individuals, especially those with hypertension, generally have impaired QOL. It has been shown that treatment of hypertension could affect QOL, and care in treatment is required because of possible effects on QOL. Given the major role of stroke in the deterioration of QOL among elderly people, treatment of hypertension may well be targeted at prevention of stroke. A recent meta-regression analysis demonstrated that calcium channel blockers are effective in reducing risk of stroke, as their effects are not limited to blood pressure reduction. Since overall benefit of hypertension treatment is determined by multiple factors, including safety, efficacy, compliance, as well as risk reduction, it is of particular importance to pay attention to QOL in the treatment of hypertension. Further clinical evidence is needed for the establishment of proper management of hypertension in the elderly, especially from the QOL point of view.     

Association of severe hypertension with pneumonia in elderly patients with acute ischemic stroke

Pneumonia is one of the most frequent complications in elderly patients with acute ischemic stroke. Although severe hypertension is often observed in the early phase of acute stroke, there are few studies of acute hypertension as a factor influencing the incidence of stroke-associated pneumonia (SAP) in elderly subjects with acute ischemic stroke. To assess the association of acute phase blood-pressure elevation with the incidence of SAP, we compared 10 elderly patients with acute ischemic stroke complicated with severe hypertension (≥ 200/120 mm Hg) with 43 patients with moderate hypertension (160-199/100-119 mm Hg), as well as with 65 control normotensive or mildly hypertensive (<160/100 mm Hg) controls on admission. Data were collected on known risk factors, type of ischemic stroke and underlying chronic conditions. The significance of differences in risk factors was analyzed using univariate and multivariate comparisons of 38 SAP cases and others, 8 SAP death cases and others, and 28 patients with poor outcome associated with in-hospital death or artificial feeding at discharge and others. After adjustment for potential confounding factors, the relative risk estimates for SAP, SAP death and poor outcome were 2.83 (95% confidence interval 1.14-7.05), 5.20 (1.01-26.8) and 6.84 (1.32-35.4), respectively, for severe hypertension relative to normotensive or mildly hypertensive controls. We conclude that severe hypertension on admission is an independent predictive factor for SAP in elderly patients with acute ischemic stroke.     

Results of clinical trials regarding the efficacy of treating hypertension

Results of recently conducted clinical trials on the efficacy of treatment of hypertension in the elderly are reviewed. The findings of these clinical trials indicate that hypertension in the elderly (that is, diastolic blood pressure of 95 mmHg and above) must be treated so that the catastrophic clinical complications of hypertension in the elderly (that is, stroke) are prevented.     

老年高血压患者颈动脉内膜-中膜层厚度的改变

目的　探讨老年高血压患者颈动脉内膜_中膜层厚度的改变。方法　应用彩色多普勒超声仪对比分析 12 7例老年高血压患者与 53例健康人颈动脉内膜_中膜层厚度的变化。结果　 1.老年高血压患者颈动脉的内膜_中膜层厚度 (IMT)值明显高于健康者 (P <0 0 1)。2 .在老年高血压组中有脑卒中的患者IMT值又明显高于无脑卒中的患者。结论　健康体检中 ,检测IMT值对预测老年高血压患者预后及脑卒中发生率有一定的临床价值。     

Long-term predictors of stroke in a cohort of people aged 70 years

This paper aims at studying the development and the risk factors for stroke prospectively during a 6-year follow-up in the Turku Elderly Study, Turku, Finland. The study cohort consisted of 1032 people aged 70 years at baseline. The stroke events (ICD-9 codes 430-434) were identified by computer linkage from the hospital discharge and death registers, and from a follow-up questionnaire. During the 6 years of follow-up, 71 patients (6.9%) suffered a stroke. Previous stroke (RR 5.82), history of transient ischemic attack (RR 4.14), diabetes mellitus (RR 2.50), poorly controlled hypertension (RR 2.42), smoking (RR 1.94) and male sex (RR 1.65) were independent risk factors for stroke. Atrial fibrillation, cardiac failure and previous myocardial infarction did not appear to be significant independent predictors of stroke in the elderly. The risk of stroke in the elderly population appears to be strongly related to the concomitant clinical disease, and this should be remembered when identifying persons at increased risk of stroke. Poorly controlled hypertension was associated with an increased risk of stroke. Thus, achieving a good control of blood pressure in elderly hypertensives receiving treatment has the potential to prevent strokes.     

上海社区老年人群高血压患病情况及其相关危险因素流行病学基线调查

目的探讨上海市社区老年居民高血压病的患病情况及主要危险因素。方法采用多级随机抽样方式,对上海市长宁区4个社区65岁及以上常住居民进行横断面调查。结果上海市社区老年居民高血压病的患病率为61．0％,男女患病率差异无统计学意义（男vs女：60．5％ vs 61．5％,P〉0．05）。高血压患病率随年龄增长呈上升趋势（χ2=88．14,P=0．000）。调查对象中,高血压自我知晓率为86．5％,控制率为56．4％。控制性别和年龄效应后,Logistic回归提示体质指数、食盐摄人量、高血压家族史、糖尿病、高脂血症、肿瘤、器质性心脏病、脑卒中与高血压患病存在相关性（P〈0．05）。结论上海市社区老年居民高血压患病率、知晓率、控制率较高,年龄、体质指数、食盐摄人量、高血压家族史是高血压的危险因素,糖尿病、高脂血症、肿瘤、器质性心脏病、脑卒中均与高血压伴发。     

北京昌平区中老年人脑卒中危险因素调查分析

目的了解北京市昌平区中老年人脑卒中发生情况及影响因素,为开展卒中干预提供依据。方法采用整群抽样的方法对昌平区40岁及以上居民进行健康调查。结果本地区中老年人脑卒中患病率为5.99%,男性患病率为7.28%,女性为5.12%,男性高于女性;以缺血型为主占92.17%、出血型占6.18%、出血缺血均有占1.65%;进行Logistic逐步回归分析,受教育程度是脑卒中保护因素,年龄、血脂异常、超重、TIA、高血压是脑卒中危险因素。结论本地区中老年人脑卒中患病率较高,缺血型为主,性别、年龄、受教育程度、血脂异常、超重、TIA、高血压是其影响因素。     

Hypertension in the elderly: Are we all on the same wavelength?

Hypertension is of frequent occurrence in the elderly population.Isolated systolic hypertension(ISH) accounts for the majority of cases of hypertension in the elderly.ISH is associated with a 2-4-fold increase in the risk of myocardial infarction,left ventricular hypertrophy,renal dysfunction,stroke,and cardiovascular mortality.There have been many studies to determine the optimal treatment for hypertension in the elderly. Why,when and how to treat hypertension in the elderly was the scope of the majority of these trials.Despite countless efforts many aspects remain obscure.While a number of novel drugs are being developed,the issue of whether all antihypertensive drugs bestow parallel benefits or whether some agents offer a therapeutic advantage beyond blood pressure control remains of crucial importance.Furthermore,the response of theelderly to different antihypertensive agents also differs from that of younger patients and may explain some of the disparities in outcomes of trials conducted in elderly patients with hypertension.     

老年高血压患者的无创血流动力学参数与心脏结构变化的关系

目的探讨老年高血压患者的无创血流动力学参数与心脏结构变化的关系。方法入选天津市人民医院心内科住院的老年原发性高血压患者261例,分为高血压Ⅰ组84例、高血压Ⅱ组100例和高血压Ⅲ组77例,选择同期住院的血压正常者58例为对照组,收集一般临床资料,心脏超声检查左心室舒张末期内径(LVEDD)、室间隔厚度、左心室后壁厚度、LVEF,计数左心室质量指数(LVMI),无创血流动力学检测每搏量、外周血管阻力(SVR)、外周血管阻力指数(SVRI)、左心做功指数(LCWI)、无创LVEF等。结果对照组、高血压Ⅰ、Ⅱ、Ⅲ组高血压史、收缩压、舒张压、脉压、左心房内径和LVMI呈明显升高趋势(P<0.05),高血压Ⅰ、Ⅱ、Ⅲ组每搏指数、每搏量、心脏指数、LVEF、LCWI呈明显降低趋势(P<0.05),SVR、SVRI呈明显升高趋势(P<0.05)。SVR和SVRI与每搏量、心排血量、心脏指数、每搏指数、LCWI、无创LVEF呈负相关(P<0.01),与高血压史、收缩压、舒张压、脉压、左心房内径、LVEDD、LVMI呈正相关(P<0.01)。SVRI的ROC曲线下面积为0.676(95%CI:0.610~0.742),诊断左心室肥厚的价值较高(P=0.000)。结论老年高血压患者的无创血流动力学呈现"减排高阻"的现象,临床可用无创血流动力学参数作为心脏结构的评估参考指标。     

澳门地区老年单纯性收缩期高血压患病率及其与脑卒中的关系

目的 调查澳门地区老年人单纯性收缩期高血压（ＩＳＨ）的患病情况,并了解其与脑卒中的关系。方法 按统一标准,以家庭为单位对５１７７人进行问卷调查,测量血压,并进行脑血管病的检诊。结果 确诊ＩＳＨ患病率为４．１７％,临界ＩＳＨ患病率为４．９％,女性患病率高于男性;确诊ＩＳＨ和临界ＩＳＨ的患病率老年组较非老年组明显增高,且女性患病率的增高更剧;随年龄增长,随卒中的危险性也增加。多因素分析显示,脑卒中与年     

Pathophysiology of hypertension in the elderly

Combined systolic and diastolic arterial hypertension and isolated systolic hypertension in the elderly are proven risk factors for stroke, sudden death, coronary artery disease, and congestive heart failure. Because hemodynamics, vascular and cardiac adaptations, fluid volume, and endocrine functions are distinctly altered in the elderly hypertensive patient compared with a younger patient, antihypertensive treatment should be individualized, and an unsophisticated regimen, such as a stepped-care approach, is too rigid to be as beneficial for elderly hypertensive patients as for young hypertensive patients.     

老年高血压合并衰弱患者降压治疗的研究进展

高血压是影响老年人健康的重要因素,降压治疗可降低老年高血压患者脑卒中、心血管事件和死亡等风险。老年人群中衰弱常与高血压并存,但目前关于老年高血压与衰弱的研究相对较少,尤其是老年高血压合并衰弱的降压治疗研究结论不一。老年高血压合并衰弱患者降压治疗的起始值与目标值、衰弱老年人能否从降压治疗中获益以及降压治疗方案的选择等仍争议较大。因此,本文对老年高血压患者合并衰弱的降压治疗进行综述。     

Management of hypertension for stroke prevention in older people.

It is no longer acceptable to attribute elevated blood pressure in elderly people to the natural processes of aging and thereby withhold treatment. Sound evidence demonstrates increased risk of cardiovascular disease with increasing levels of blood pressure and decreased incidence of cardiovascular disease with blood pressure control. Hypertension is known to be the most modifiable risk factor for stroke. Given projected demographic shifts in the population, the number of older Americans with hypertension and increased risk of morbidity and mortality from stroke will grow during the first part of the next century. Health care providers should familiarize themselves with the unique pathophysiology of hypertension in elderly people, and integrate appropriate approaches to comprehensive evaluation and management into practice.     

Twenty-four hour blood pressure monitoring in the Syst-Eur trial.

This article describes the objectives and protocol of a study on ambulatory blood pressure in elderly patients with isolated systolic hypertension. This study constitutes an optional side-project to the Syst-Eur trial. The multicentre Syst-Eur trial investigates whether antihypertensive treatment of elderly patients with isolated systolic hypertension will influence the incidence of stroke. Secondary endpoints include cardiovascular events, such as myocardial infarction. The main objective of the side-project is to investigate whether ambulatory blood pressure monitoring will improve the prediction of cardiovascular complications based on blood pressure measurement in the clinic. The side-project also provides the opportunity to evaluate the diurnal profile of blood pressure in elderly patients with isolated systolic hypertension randomized to placebo or active antihypertensive treatment.     

Effect of hypertension status on the association between sleep duration and stroke among middle‐aged and elderly population

We aimed to examine whether hypertension status modified the association between sleep duration and stroke among middle‐aged and elderly population. This cross‐sectional study included 10 516 participants aged ≥45 years from the China Hypertension Survey study. Sleep duration and history of stroke were assessed by questionnaires. Multivariate logistic regression analyses, a generalized additive model (GAM) and smooth curve fitting (penalized spline method) and a two‐piecewise logistic regression models were performed to evaluate the association between sleep duration and stroke in different status of hypertension. 95% confidence interval (CI) for turning point was obtained by bootstrapping. Multiple logistic analyses showed that per 1 hour increase in sleep duration was associated with a 37% increased prevalence of stroke among participants without hypertension and associated with a 8% increased prevalence of stroke among hypertensive participants (without hypertension: odds ratio [OR] = 1.37, 95% CI 1.09‐1.71; with hypertension: OR = 1.08, 95% CI 0.95‐1.21; P_Interaction = .029). The fully adjusted smooth curves presented a linear association between sleep duration and stroke among participants without hypertension, but a threshold, nonlinear association among hypertensive participants. The turning point for the curve was found at a sleep duration of 8 (95% CI 5‐9) h among hypertensive patients. The ORs (95% CIs) for stroke were 0.92 (0.79, 1.06) and 1.60 (1.23, 2.08) to the left and right of the turning point, respectively. In conclusion, we found a linear association between sleep duration and stroke among middle‐aged and elderly participants without hypertension, but a threshold, nonlinear association among hypertensive participants.     

Hypertension in the elderly

Hypertension in the older population has a serious prognosis and this is true even for isolated systolic hypertension. There is a markedly increased risk of stroke, cardiovascular disease and central nervous system in such patients. The hemodynamics in hypertension of the elderly differs in a number of parameters from hypertension in the younger patient. In addition, drug metabolism is markedly altered by the aging process. This combination of factors requires a selective choice of agents for the management of hypertension in the elderly. The role of various drug modalities and their efficacy is reviewed in this presentation.