Characteristics of hypertension subtypes and treatment outcome among elderly Korean hypertensives

There are limited data about characteristics of hypertension subtypes in Asian hypertensive patients and their impacts on treatment of hypertension. This prospective, multi-center, observational study evaluated 2439 hypertensive patients. (≥60 years) Inadequately controlled and drug-naïve patients were categorized into three hypertension subtypes (isolated systolic hypertension [ISH], combined systolic/diastolic hypertension [SDH], and isolated diastolic hypertension [IDH]), and proportions of each hypertension subtype were evaluated. After 6-month strict treatments, we compared the characteristics of patients who did not achieve target BP with those who did. In overall population, ISH was the most common subtype (53.2%; 1297/2439). However, in drug-naïve patients, SDH was the predominant hypertension subtype (59.6%; 260/436). Notably, the proportion of ISH was substantially lower than previously known data. Predictors associated with failure of reaching target BP were old age (>70 years), hypertension awareness, and baseline systolic blood pressure (≥160 mm Hg) for total patients. In drug naïve patients, hypertension awareness, ISH, and microalbuminuria were associated with treatment failure. These findings might have an impact on the evaluations and antihypertensive treatments of elderly Korean patients.     

Prevalence of isolated systolic and isolated diastolic hypertension subtypes in China

BACKGROUND: Isolated systolic hypertension (ISH), more so than any other hypertension subtype, increases the risk for stroke and coronary heart disease. The prevalence of ISH versus other hypertension subtypes in the general Chinese adult population is not known. METHODS: The prevalence of isolated systolic and isolated diastolic hypertension (IDH) was examined in a representative national sample of 15,540 Chinese adults aged 35 to 74 years. Three seated blood pressure (BP) measurements taken after 5 min of rest were averaged and hypertension subtypes were defined among individuals not receiving antihypertensive therapy as follows: ISH as systolic BP >/=140 mm Hg and diastolic BP <90 mm Hg; IDH as systolic BP <140 mm Hg and diastolic BP >/=90 mm Hg; and combined systolic/diastolic hypertension (SDH) as a systolic BP >/=140 mm Hg and diastolic BP >/=90 mm Hg. RESULTS: Overall, 7.6% of the Chinese adult population had ISH, 7.4% had SDH, and 4.4% had IDH. The prevalence of ISH increased with age and was more common in older women than in older men. Stage 1 hypertension was much more prevalent than stage 2 hypertension among all hypertension subtypes. The prevalence of SDH, IDH, and ISH (women, only) were higher in northern China than southern. The prevalence of ISH and SDH (women, only) were higher among rural residents versus urban residents. CONCLUSIONS: These data document high rates of ISH in China. Given the risk of cardiovascular disease associated with ISH, our findings underscore the critical need for enhanced hypertension screening and treatment programs in China.     

Efficacy and safety of an oral fixed low-dose perindopril 2 MG/indapamide 0.625 MG combination: a randomized, double-blind, placebo-controlled study in elderly patients with mild to moderate hypertension.

The efficacy and safety of 12 weeks treatment with an oral fixed low-dose perindopril 2 mg + indapamide 0.625 mg (Per/Ind) combination in elderly and very elderly patients (65-85 years) with mild to moderate systolic and diastolic hypertension (SDH) or isolated systolic hypertension (ISH) were investigated vs placebo. This trial was a multinational randomized double-blind study with doubling of active drug dosage in nonresponders. Intention to treat analysis was performed in 383 patients (age 72.4 years; ISH 32%). 58.5% remained on their initial dosage. Per/Ind decreased supine diastolic and systolic blood pressure (sDBP/sSBP) by 13.2+/-8.0 mm Hg and 22.5+/-13.9 mm Hg (P <.0001) versus placebo -7.3+/-9.0 mm Hg and -12.3+/-15.2 mm Hg, respectively. In ISH (n = 123), Per/Ind decreased sSBP by 23.0+/-11.8 mm Hg (P <.0001). Overall response and normotension rates was 81.3% with Per/Ind (P <.0001). Adverse event rates (including hypokalemia) were similarly low in both groups. Analysis in the over-75 year subgroup showed similar safety and efficacy results. Fixed low-dose Per/Ind is a safe and effective treatment of hypertension including isolated systolic hypertension in the elderly.     

The placebo effect and white coat effect in isolated systolic hypertension and systo-diastolic hypertension

It is well recognised from many clinical trials that there is a blood pressure lowering effect when placebo is administered to patients with essential hypertension ("placebo effect"). The reduction in blood pressure, however, may also be partly due to loss of the alerting response ("white coat effect") as a result of familiarisation with the clinical environment. To investigate the hypothesis that there may be a more marked placebo effect and white coat effect in isolated systolic hypertension (ISH) compared with systo-diastolic hypertension (SDH), we studied 78 patients with hypertension: 34 had ISH and 44 patients had SDH. The 34 patients with ISH were older (68.7 vs 54.9 years), had a higher SBP (192.2 vs 169.6 mmHfg) and lower DBP (85.5 vs 102.0 mmHg) when compared to patients with SDH. Amongst the patients with ISH, there were no significant changes in mean blood pressures pre-placebo (paired t-test, p = NS). In the placebo period, there was a significant reduction in systolic blood pressures at all three points, and a significant reduction in diastolic blood pressures after 2 and 3 months placebo (paired t-test, p < 0.05). There was a mean reduction in mean systolic blood pressure at visit 1 by 5.2%, visit 2 by 5.1% and visit 3 by 4.6%, when compared to mean pre-placebo systolic blood pressures (p < 0.05). The mean reduction in diastolic blood pressure was 5.8% at visit 2 and 3.5% at visit 3, when compared to mean pre-placebo diastolic blood pressure (p < 0.05). At the 4-week visit after receiving placebo, the mean systolic blood pressure decreased by 9.4 mmHg (p = 0.003) and mean diastolic blood pressure by 2.7 mmHg (p = NS) in the patients with ISH. In patients with SDH, there were no statistically significant changes in recorded BP readings following the introduction of placebo. We suggest blood pressures in some patients with ISH may settle with careful follow up and initiation of treatment in these patients could potentially be delayed for at least 3 months, as therapy may not prove necessary.     

Cardiovascular remodeling is greater in isolated systolic hypertension than in diastolic hypertension in older adults: the Insufficienza Cardiaca negli Anziani Residenti (ICARE) a Dicomano Study

OBJECTIVE: We investigated cardiac and vascular remodeling in an unselected older population with either diastolic hypertension (HTN) or isolated systolic hypertension (ISH). BACKGROUND: Isolated systolic hypertension accounts for a substantial proportion of hypertension in individuals older than 65 years and is strongly associated with an increased risk of cardiac and cerebrovascular events. The exact mechanisms underlying the increased risk associated with ISH and elevated pulse pressure (PP), in comparison with HTN, have not been extensively investigated. METHODS: Community-dwelling residents age >/=65 years in a small town in Italy (Dicomano) were enrolled. Untreated subjects considered in this study included 173 normotensive subjects (blood pressure [BP] <140/90 mm Hg), 95 subjects with HTN (diastolic BP >/=90 mm Hg), and 43 subjects with ISH (BP >/=160/<90 mm Hg). All subjects underwent extensive clinical examination, echocardiography, carotid ultrasonography, and carotid applanation tonometry. RESULTS: Subjects with ISH had higher left ventricular (LV) mass, which was independently related to PP but not to systolic or mean pressures. Both carotid wall cross-sectional area and vascular stiffness were greater in ISH patients than in HTN and normal subjects and were independently related to PP but not to systolic BP. In addition, ISH was associated with a higher prevalence of carotid plaque and more extensive carotid atherosclerosis. CONCLUSIONS: In our community-based elderly population, individuals with ISH had higher prevalences of LV hypertrophy and carotid atherosclerosis than subjects with HTN despite lower mean BP. These findings provide potential pathophysiologic mechanisms underlying the associations of ISH and PP with increased risk of cardiovascular morbidity and mortality.     

Stroke risk in systolic and combined systolic and diastolic hypertension determined using ambulatory blood pressure. The Ohasama study

BACKGROUND: To investigate the risk of stroke in subjects with isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and combined systolic and diastolic hypertension (SDH) in a Japanese general population, we used 24-h ambulatory blood pressure (ABP) and casual-screening blood-pressure (CBP) readings. METHODS: Subtypes of hypertension were defined based on systolic blood pressure (SBP) >135 mm Hg or diastolic blood pressure (DBP) >80 mm Hg for 24-h ABP, and SBP >140 mm Hg or DBP >90 mm Hg for CBP. We obtained 24-h ABP and CBP data for 1271 (40% male) subjects aged > or =40 years (mean age, 61 years) without a history of symptomatic stroke; their stroke-free survival was then determined. The prognostic significance of each subtype of hypertension was determined by Cox proportional hazard analysis. RESULTS: There were 113 symptomatic strokes during follow-up (mean time, 11 years). Compared with normotension, among the hypertension subtypes determined by 24-h ABP, the adjusted relative hazards (RHs) of stroke were 2.24 for ISH (P = .002) and 2.39 for SDH (P = .0004). The association was less marked among subtypes determined by CBP (RH = 1.40 and P = .13 for ISH; RH = 2.07 and P = .017 for SDH). The IDH group was excluded from the Cox analysis because both the prevalence and the number of events were low in this group. CONCLUSIONS: Isolated systolic hypertension, as determined by 24-h ABP measurements, was associated with a high risk of stroke, similar to that found in SDH subjects; this suggests that the prognosis of hypertensive patients would be improved by focusing treatment on 24-h systolic ABP.     

Systolic blood pressure reduction with olmesartan medoxomil versus nitrendipine in elderly patients with isolated systolic hypertension

OBJECTIVE: The prevalence of isolated systolic hypertension (ISH) is high in the elderly, and the objective of this study was to compare the antihypertensive efficacy of olmesartan medoxomil with that of nitrendipine in elderly (65-74 years) and very elderly (>/= 75 years) male and female patients with ISH. METHODS: Patients were randomized to 24 weeks of treatment with either olmesartan medoxomil 20 mg daily (n = 256) or nitrendipine 20 mg (n = 126) twice daily, with possible dose increase (to 40 mg daily) and addition of hydrochlorothiazide (HCTZ) 12.5 or 25 mg daily if required. RESULTS: On the primary endpoint [reduction in mean sitting systolic blood pressure (SBP) after 12 weeks of treatment], the two treatments were similar (olmesartan medoxomil, -30.0 mmHg; nitrendipine, -31.4 mmHg). No significant difference between the treatment groups was observed, and non-inferiority of olmesartan medoxomil to nitrendipine was demonstrated using an analysis of covariance (ANCOVA) model. Reductions in mean sitting and standing SBP and diastolic blood pressure (DBP) up to week 24 were also similar with both treatments. Blood pressure (BP) goal attainment rates (sitting SBP 相似文献   

Blood pressure categories, hypertensive subtypes, and the metabolic syndrome

BACKGROUND: Elevated blood pressure (BP) is one element of metabolic syndrome (MetS); however, the relation of various BP categories and hypertension subtypes to the likelihood of having MetS is not well defined. METHODS: We determined the odds of MetS, defined by the National Cholesterol Education Program, in various BP categories from a cross-sectional study of 5968 individuals aged at least 18 years and untreated for hypertension (weighted to 124.7 million) in the National Health and Nutrition Examination Survey, 1999-2002. Nonhypertensive BP categories were optimal, normal, and high-normal BP, according to JNC-VI classification. Hypertension consisted of three subtypes: isolated diastolic hypertension (IDH), systolic-diastolic hypertension (SDH), and isolated systolic hypertension (ISH). RESULTS: Among those with hypertension and MetS, 25.3% had IDH, 20.2% had SDH, and 54.5% had ISH. The MetS prevalence in nontreated persons was 5.8% for optimal BP, 9.1% for normal BP, 38.2% for high-normal BP, 45.9% for IDH, 44.3% for SDH, and 43.9% for ISH. Risk factor odds ratios (95% confidence intervals; reference group, optimal BP), adjusted for age, sex, total cholesterol, and smoking, were 1.6 (1.2-2.2) for normal BP, 9.4 (6.9-12.7) for high-normal BP, 14.7 (8.9-24.0) for IDH, 12.2 (7.2-20.8) for SDH, and 10.2 (7.0-14.9) for ISH (all P < 0.01); odds ratios were higher for women in all categories. CONCLUSIONS: Despite having the lowest mean age, IDH subtype is associated with greatest likelihood of MetS. The high frequency of ISH in the hypertensive population, however, makes ISH the most common hypertensive subtype in persons with MetS.     

Uncontrolled Hypertension in Uganda: A Comparative Cross‐Sectional Study

In a community survey, 4432 persons aged 15 years and older in two districts in Uganda were studied. Blood pressure was measured and predictors for subtypes of uncontrolled hypertension (HTN) were assessed using bivariate and multivariate logistic regression modeling. Prevalence of uncontrolled HTN was 20.2% and the subgroups of isolated systolic HTN (ISH), isolated diastolic HTN (IDH), and systolic‐diastolic HTN (SDH) were 7.2%, 4.2%, and 8.8%, respectively. No difference was observed between the sexes. For all HTN subtypes, middle (35–49 years) and older age (50+) groups had a higher prevalence compared with younger subjects (15–34 years) (all P<.001). IDH prevalence in older age was not higher compared with younger age (P=.417). After multivariate analysis, middle age predicted all subtypes of HTN and old age predicted ISH and SDH. Alcohol consumption predicted IDH and SDH. Uncontrolled HTN in this population increases in the order IDH, ISH, and SDH, with more than 1 in 5 having uncontrolled HTN.     

原发性高血压病患者血压昼夜节律的临床意义探讨

目的 探讨原发性高血压病患者昼夜血压均值波动的节律与临床意义。方法 ９２例原发性高血压病人分成三组,单纯收缩压增高组（ＩＳＨ）３６例,收缩压和舒张压均增高认定为混合组（ＭＤＨ）,共３１例,二组均除外心,脑,肾损害。高血压合并左心室肥大（ＬＶＨ）组２５例。２０例正常个体为对照组,仪器采用美国Ｓｐａｃｅｌａｂｓ ９０２０７无创性携带式血压监测仪,获取２４小时平均收缩压（２４ｈＳＢＰ０和舒张压（２４ｈＤ     

The contribution of the systolic and diastolic components for the diagnosis of arterial hypertension under the 2017 ACC/AHA Guideline and metabolic heterogeneity among individuals with Stage 1 hypertension

Little is known about the impact of the 2017 ACC/AHA hypertension guideline on the distribution pattern of hypertension modalities (isolated systolic hypertension [ISH], isolated diastolic hypertension [IDH], and systolic‐diastolic hypertension [SDH]). This cross‐sectional study had the following objectives: to compare the prevalence of hypertension, ISH, IDH, and SDH, according to the definitions of the JNC 7 or the 2017 guideline; to determine the relative contribution of the systolic and the diastolic components for the diagnosis of hypertension; and to compare the metabolic profile of ISH, IDH, or SDH among new hypertensive individuals by the 2017 guideline. The authors retrospectively evaluated 33 594 patients (42 ± 10 years, 67% male) who underwent a routine health evaluation. Hypertensive patients not using antihypertensive medication were classified into ISH, IDH, or SDH using guideline‐defined thresholds. The prevalence of hypertension increased from 21.1% by the JNC 7 definition to 54.7% using the 2017 criteria (2.6‐fold increase). More profound increases were seen in the prevalence of IDH (8.7‐fold) and SDH (3.3‐fold), whereas the prevalence of ISH reduced from 1.1% (JNC 7) to 0.5% (2017 definition). Among patients with Stage 1 hypertension by the 2017 document, 85% had IDH and fewer metabolic abnormalities compared to those with SDH or ISH. The authors concluded that the 2017 guideline inflates the role of the diastolic component and diminishes the contribution of the systolic component for the diagnosis of hypertension. Individuals with Stage 1 hypertension by the 2017 guideline are metabolically heterogeneous and may have different long‐term prognoses.     

Coronary Microvascular Function in Patients With Isolated Systolic and Combined Systolic/Diastolic Hypertension

J Clin Hypertens (Greenwich). 2012;14:871–876. ©2012 Wiley Periodicals, Inc.Isolated systolic hypertension (ISH) is a common condition in the elderly that is associated with endothelial dysfunction. Concerning the effect of type of hypertension on coronary microvascular function, coronary flow reserve (CFR) in patients with ISH was evaluated and the results were compared with patients with combined systolic/diastolic hypertension (SDH). Seventy‐six elderly patients (older than 60 years) who were free of coronary artery disease and diabetes mellitus were enrolled in the study (38 with ISH and 38 with combined SDH). Using transthoracic Doppler echocardiography, CFR was calculated as the ratio of hyperemic to baseline diastolic peak flow velocities. A CFR value of >2 was accepted as normal. The mean age was 68.6±6.3 years and the groups had similar features with regard to demographic and clinical characteristics. Patients with ISH had significantly lower CFR values compared with those with combined SDH (2.22±0.51 vs 2.49±0.56, respectively; P=.03). On multivariate regression analysis, ISH (β=−0.40, P=.004) and dyslipidemia (β=−0.29, P=.04) were the independent predictors of CFR. These findings indicate that CFR, an indicator of coronary microvascular/endothelial function, is impaired more profoundly in patients with ISH than in patients with combined SDH.

Hypertension, which is a common condition in the population, is one of the major and modifiable risk factors for atherosclerosis. Around 50% of people older than 60 years have been demonstrated to have hypertension and in around half of these cases, hypertension was reported to be in the form of isolated systolic hypertension (ISH). ¹ , ² In contrast, in younger patients (younger than 50 years), combined systolic/diastolic hypertension (SDH) is the predominant form of hypertension characterized by increased systolic and diastolic blood pressure (BP) or diastolic BP alone.Endothelial dysfunction, characterized by decreased nitric oxide bioavailability, is a key event in the progression of atherosclerosis, and when detected in the systemic or coronary circulation, it is an independent predictor of cardiovascular mortality. ³ , ⁴ Atherosclerotic risk factors, including hypertension, are associated with systemic endothelial dysfunction and increased arterial stiffness.Determining coronary flow reserve (CFR) by transthoracic Doppler echocardiography (TTDE) has been introduced as a reliable and reproducible indicator of coronary microvascular‐endothelial function. Demonstrating CFR noninvasively by TTDE has been shown to have a strong correlation with CFR obtained invasively by intracoronary Doppler wire and positron emission tomography. ⁵ , ⁶ Coronary endothelial dysfunction has been reported to be of prognostic significance and an early manifestation of atherosclerosis and CAD. ⁴ , ⁷ Previously, Erdogan and colleagues ⁸ reported that coronary microvascular function is impaired in patients with hypertension. In that study, patients with prehypertension, compared with controls, were also found to have decreased CFR. However, there are no data describing the impact of ISH on coronary microvascular function.Keeping these data in mind, and concerning the effect of type of hypertension on coronary microvascular function, we aimed to evaluate CFR in patients with ISH and compare the results with that obtained from patients with SDH.     

Blunted nocturnal fall in blood pressure and left ventricular mass in elderly individuals with recently diagnosed isolated systolic hypertension

BackgroundFew studies have investigated the relationship between the lack of or reduction of nocturnal blood pressure (BP) fall and left ventricular mass (LVM) in elderly individuals with isolated systolic hypertension (ISH), notwithstanding the fact that ISH is the most frequent subtype of uncontrolled hypertension and a powerful risk factor for organ damage. The aim of this study was to identify the relationship between blunted nocturnal BP fall and LVM in elderly individuals with ISH that was recently diagnosed (within 2 years) and had never been treated.MethodsA total of 64 elderly patients with recent ISH were recruited among the outpatients of the Hypertension Unit at 1st Institute of Medicine of “La Sapienza” University in Rome, and they underwent 24-h ambulatory BP monitoring (ABPM). According to exclusion criteria, 37 patients were selected for the study. Based on the presence or absence of an almost 10% reduction in systolic BP (SBP) and diastolic BP (DBP) from day to night, 21 so-called dippers and 16 nondippers, respectively, were identified. All of these 37 patients underwent echocardiography. Relationships between BP recordings and echocardiographic parameters were assessed by univariate analysis. Dippers and nondippers were compared with respect to LVM.ResultsNighttime SBP was closely associated with indexed LVM (LVM/h^2.7) (r = 0.564; P=.001). Nondippers showed significantly higher LVM/h^2.7 compared with dippers (62.43 ± 15.39 g/m^2.7 v 51.33 ± 12.68 g/m^2.7 respectively; P= .021).ConclusionsAn association between blunted nocturnal SBP fall and increased LVM was observed in the early phases of ISH in the elderly. This finding may have important prognostic implications.     

Blood pressure control in the Hypertension in the Very Elderly Trial (HYVET)

To report blood pressure control in the Hypertension in the Very Elderly Trial, a placebo-controlled trial of hypertensive (systolic blood pressure (SBP) 160-199?mm?Hg, diastolic blood pressure (DBP) <110?mm?Hg) participants over the age of 80 years, given treatment in three steps: indapamide slow release 1.5?mg alone, indapamide plus 2?mg perindopril and indapamide plus 4?mg perindopril. The difference in control between participants with combined systolic and diastolic hypertension (SDH, DBP90?mm?Hg) and those with isolated systolic hypertension (ISH, DBP<90?mm?Hg) is determined together with the effects of increments in the treatment regimen. At 2 years, the active treatment lowered blood pressure by 16.5/6.9?mm?Hg more than that on placebo in participants with SDH and by 19.3/4.8?mm?Hg more in those with ISH. The 2-year falls in pressure on placebo alone were 13.2/8.5?mm?Hg in SDH and 8.2/1.5?mm?Hg in ISH participants. With full titration of active treatment, 62% of SDH participants achieved goal SBP (<150?mm?Hg) by 2 years and 71% of those with ISH. The corresponding results for DBP control (<80?mm?Hg) were 40 and 78%. The addition of active perindopril 2?mg roughly doubled the percentage controlled, as did increasing to 4 from 2?mg. Blood pressure control was good with ISH and better than with SDH. The fall in SBP accounted for the observed 30% reduction in strokes, but the 21% reduction in total mortality and 64% reduction in heart failure were greater than predicted.     

社区人群高血压类型与脑卒中发病关系研究

目的了解不同高血压类型与脑卒中发病之间的关系。方法收集年龄≥35岁社区人群的数据资料,对36836例基线调查时测得的血压与随访3 a监测的脑卒中发病情况进行相关分析,将新发脑卒中作为研究终点。结果高血压患病率约为23.9%;其中单纯收缩期高血压（ISH）患病率为11.1%,单纯舒张期高血压（IDH）为2.3%,混合型高血压（SDH）为10.5%。随访114339人年,共发生脑卒中事件356例,其中缺血性卒中240例,出血性卒中97例,未分类卒中19例,总脑卒中的发病率为311.4/10万人年。SDH组发生脑卒中的危险比其他组高,其发生总的脑卒中、缺血性卒中和出血性卒中的相对危险度及95%CI分别为3.03（2.20-4.15）、2.66（1.81-3.90）、3.09（1.67-5.69）。SDH组男性发生脑卒中的危险比女性高。结论ISH的患病率比IDH高,二者均会增加发生脑卒中的危险。SDH患者发生脑卒中的危险性最高,应该及时积极治疗。     

Prediction of hypertensive crisis based on average, variability and approximate entropy of 24-h ambulatory blood pressure monitoring

Approximate entropy (ApEn) of blood pressure (BP) can be easily measured based on software analysing 24-h ambulatory BP monitoring (ABPM), but the clinical value of this measure is unknown. In a prospective study we investigated whether ApEn of BP predicts, in addition to average and variability of BP, the risk of hypertensive crisis. In 57 patients with known hypertension we measured ApEn, average and variability of systolic and diastolic BP based on 24-h ABPM. Eight of these fifty-seven patients developed hypertensive crisis during follow-up (mean follow-up duration 726 days). In bivariate regression analysis, ApEn of systolic BP (P<0.01), average of systolic BP (P=0.02) and average of diastolic BP (P=0.03) were significant predictors of hypertensive crisis. The incidence rate ratio of hypertensive crisis was 14.0 (95% confidence interval (CI) 1.8, 631.5; P<0.01) for high ApEn of systolic BP as compared to low values. In multivariable regression analysis, ApEn of systolic (P=0.01) and average of diastolic BP (P<0.01) were independent predictors of hypertensive crisis. A combination of these two measures had a positive predictive value of 75%, and a negative predictive value of 91%, respectively. ApEn, combined with other measures of 24-h ABPM, is a potentially powerful predictor of hypertensive crisis. If confirmed in independent samples, these findings have major clinical implications since measures predicting the risk of hypertensive crisis define patients requiring intensive follow-up and intensified therapy.     

Treatment and blood pressure control in isolated systolic hypertension vs diastolic hypertension in primary care

Cross-sectional surveys on prevalence, treatment and control of hypertension could not satisfactorily distinguish between diastolic hypertension and isolated systolic hypertension because the definition of hypertension included patients under pharmacological treatment. We assessed the situation in the two types of hypertension in general practice in Belgium, based on current blood pressure (BP) measurements and on BP prior to the initiation of drug therapy. Participating physicians enrolled the first 15 at least 55-year-old men visiting the surgery, measured their BP and recorded data on medical history including pretreatment BP, drug utilization, cardiovascular risk factors and target organ damage. Diastolic hypertension was defined as diastolic BP> or =90 mmHg, irrespective of systolic BP, and isolated systolic hypertension as systolic BP > or =140 mmHg and diastolic BP < 90 mmHg. Among 3761 evaluable patients, 74% were hypertensive. Among the 1533 hypertensive patients in whom blood pressure was known prior to treatment (n=965) or who were untreated at the study visit (n=568), 1164 had diastolic hypertension and 369 isolated systolic hypertension. The prevalence of antihypertensive treatment was, respectively, 75 and 25% (P<0.001) in these two types of hypertension. The odds of being treated were independently determined by type of hypertension, severity of hypertension and level of risk (P<0.001). BP was controlled in 25% of all patients with diastolic hypertension and in 13% of all patients with isolated systolic hypertension (P<0.001). About half of the treated patients with systolic hypertension were on a diuretic and/or a calcium-channel blocker. In conclusion, isolated systolic hypertension is less frequently treated than diastolic hypertension, overall BP control is poor and actual drug therapy diverges from recommendations based on placebo-controlled intervention trials.     

Safety and efficacy of the oral direct renin inhibitor aliskiren in elderly patients with hypertension

OBJECTIVES: To evaluate the efficacy, safety and tolerability of aliskiren in elderly patients (> or =65 years old) with essential hypertension. METHODS: In this double-blind, multicenter study, 355 elderly patients with hypertension [office mean sitting systolic blood pressure (msSBP) > or =145-<180 mmHg and mean 24-h ambulatory systolic BP (ASBP) > or =135 mmHg] were randomized to once-daily treatment for 8 weeks with aliskiren 75 mg (n = 91), 150 mg (n = 84), 300 mg (n = 94) or the comparator lisinopril 10 mg (n = 86). The primary efficacy variable was change in mean 24-h ASBP. RESULTS: At endpoint, aliskiren 75 mg, 150 mg, 300 mg and lisinopril 10 mg lowered mean 24-h ASBP (least-squares mean+/-SEM) by 8.4+/-0.8, 7.1+/-0.8, 8.7+/-0.8 and 10.2+/-0.9 mmHg, and mean 24-h ambulatory diastolic BP by 4.5+/-0.5, 3.6+/-0.5, 3.9+/-0.5 and 6.3+/-0.5 mmHg, respectively, with no significant difference between aliskiren doses. The trough-to-peak ratio for ASBP reduction with aliskiren 75 mg, 150 mg, 300 mg and lisinopril 10 mg was 0.77, 0.64, 0.79 and 0.87, respectively. All treatments lowered office msSBP and mean sitting diastolic BP (msDBP) compared with baseline. A significantly greater proportion of patients receiving aliskiren 300 mg achieved BP control (msSBP/msDBP <140/90 mmHg) compared with those receiving aliskiren 75 mg (36.2% vs 24.2%, p = 0.033). There was no evidence of dose-related increases in the rate of adverse events with aliskiren treatment. CONCLUSIONS: Aliskiren, a novel direct renin inhibitor, provides effective 24-h BP lowering with no evidence of dose-related increases in the incidence of adverse events in elderly patients with hypertension.     

Effect of antihypertensive treatment in elderly hypertensive patients with cardiac hypertrophy]

In elderly hypertensive patients effect of antihypertensive treatment with Ca antagonist or ACE inhibitor on the heart were examined. Twenty-four elderly hypertensive patients with cardiac hypertrophy, aged 65-79 years old (mean +/- SEM, 71 +/- 1) were treated with Ca antagonist (nifedipine or nicardipine) or ACE inhibitor (captopril or enalapril) for 3 months. Thirteen patients had essential hypertension (EH: SBP greater than or equal to 160 mmHg and DBP greater than or equal to 95 mmHg, 70 +/- 1 years) and 11 had isolated systolic hypertension (ISH: SBP greater than or equal to 160 mmHg and DBP less than 95 mmHg, 74 +/- 2 years). Blood pressure (BP) and heart rate were measured every two weeks. In all patients, M-mode echocardiography was performed to measure left ventricular mass index (LVMI) and ejection fraction (EF), and the sympathetic nervous (plasma norepinephrine and epinephrine) and the renin-angiotensin system (plasma renin activity and aldosterone concentration), were assessed before and after 3 months of treatment. BP significantly decreased from 174 +/- 3/97 +/- 1 to 149 +/- 4/84 +/- 2 mmHg in EH and from 167 +/- 3/82 +/- 2 to 144 +/- 4/74 +/- 2 mmHg in ISH. LVMI was significantly reduced from 204 +/- 14 to 174 +/- 16 g/m2 in EH and from 179 +/- 14 to 156 +/- 12 g/m2 in ISH. EF showed no significant changes in either group. In ISH, the change in LVMI was significantly correlated with the change in systolic BP (r = 0.74, p less than 0.05). In EH, there was no significant relation between BP and LVMI changes.(ABSTRACT TRUNCATED AT 250 WORDS)     

Combined associations of general obesity and central obesity with hypertension stages and phenotypes among children and adolescents in Zhejiang,China

General and central obesity are suggested to be associated with elevated blood pressure (BP), whereas few studies have investigated their combined associations with hypertension in children. This study aimed to assess the associations of combinations of general obesity and central obesity with hypertension in Chinese children, including its stages and phenotypes. A total of 5430 children aged 7–17 years in Zhejiang Province were enrolled. General obesity was evaluated by body mass index (BMI), while central obesity was by waist circumference (WC). Then all children were sorted into three mutually exclusive groups: normal weight with or with no central obesity (NW), abnormal weight with no central obesity (AWNCO), and abnormal weight with central obesity (AWCO). Hypertension was defined as either a systolic or diastolic BP ≥ 95th percentile, and further classified into stage 1 hypertension, stage 2 hypertension, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH), and systolic diastolic hypertension (SDH). Logistic regression was used. AWNCO and AWCO were associated with stage 1 hypertension (AWNCO, odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.59-2.37; AWCO, 2.67, 2.20-3.25), stage 2 hypertension (AWNCO, 2.35, 1.33-4.13; AWCO, 4.53, 2.79-7.37), ISH (AWNCO, 2.50, 1.96-3.18; AWCO, 3.95, 3.15-4.95), and SDH (AWNCO, 2.48, 1.75-3.52; AWCO, 2.78, 1.94-3.99). Children with AWCO were more likely to have stage 1 and stage 2 hypertension, as well as ISH and SDH. The combined measurement of general and central obesity is suggested as an appropriate screening tool for hypertension among children and adolescents.