Antihypertensive treatment guideline for elderly hypertension

Recently published Hypertension Treatment Guideline by Japanese Society of Hypertension (JSH2000) contains several unique suggestions for treatment of elderly hypertension in particular. In general, the therapeutic goal of blood pressure in the elderly is set at a higher level than that in the young. For the patients of age 70 and over blood pressure should be controlled less than 150-160 mmHg. The following drugs are recommended as the first line drug in the elderly hypertension: 1. long-acting Ca antagonists, 2. ACE inhibitors (or angiotensin II antagonists) and 3. small dose of diuretics. Combination therapy should be considered when monotherapy of more than 2 to 3 months is not successful to reduce blood pressure below 150/90 mmHg.     

Antihypertensive effects of parenteral nicardipine alone and in combination with captopril

We studied the safety and efficacy of intravenous nicardipine alone and in combination with oral captopril. Sixteen patients with essential hypertension received a single oral dose of captopril, 50 mg, to be certain that excessive hypotension would not occur. Nicardipine was given intravenously as a 2 mg bolus, followed by an infusion at a rate designed to lower the supine diastolic blood pressure at least 10 mm Hg; then oral captopril, 50 mg, or placebo was given. The next week, nicardipine was again infused, but the alternate oral treatment was given. Intravenous nicardipine reduced blood pressure from 156 +/- 15/101 +/- 5 mm Hg (mean arterial blood pressure 120 +/- 6 mm Hg) to 140 +/- 11/88 +/- 4 mm Hg (mean arterial blood pressure 105 +/- 5 mm Hg). When captopril was added to nicardipine, the mean arterial blood pressure fell an additional 8 mm Hg but the heart rate did not increase. The combination of angiotensin-converting enzyme inhibition and calcium channel blockage produces additive antihypertensive effects without additional reflex tachycardia.     

综合干预对老年高血压患者降压效果的研究

目的探讨综合干预对老年高血压患者的降压效果。方法选择本院收治的80例患者随机分为干预组(n=41)和对照组(n=39)。对照组患者给予常规降压药物治疗及血压监测、并发症预防等基础护理,干预组在此基础上根据患者综合情况给予运动干预、饮食干预及健康教育等措施。比较2组患者干预后降压效果、干预前后血压变化情况、脑卒中事件发生情况及不良反应发生情况。结果干预后,2组患者的收缩压和舒张压均有所降低,2组收缩压和舒张压比较,差异均有统计学意义(P0.05)。干预组患者降压有效率为90.24%,明显高于对照组的66.67%(P0.05);干预组脑卒中发生率为4.88%,低于对照组的20.51%(P0.05)。结论给予老年高血压患者综合干预,可以有效提高临床治疗效果,控制患者血压水平,降低脑卒中等不良事件的发生率,提高患者生存质量,值得推广应用。     

Antihypertensive therapy in the elderly

Control of hypertension in the elderly has been shown to reduce cardiovascular morbidity. Although it is not known if this is also true for isolated systolic hypertension, drug treatment should be considered for systolic pressures over 170 mm Hg that cannot be controlled with nondrug therapy. The diuretics, calcium channel blockers, and the ACE inhibitors are very effective and generally well-tolerated therapy for the elderly. It may be necessary to combine two of these agents for some patients. Beta blockers are particularly useful for patients with ischemic heart disease or prior myocardial infarction. Beta blockers are the only agents which have been shown to be cardioprotective. For all antihypertensive agents, the elderly should be started on low doses. The drugs should then be titrated slowly if necessary. It is common for the elderly to respond to lower dosages than younger patients, and they should be monitored carefully for adverse reactions to medications. Antihypertensives should be administered once or twice daily whenever possible. If these principles are considered, most patients can be effectively controlled with a minimum of side effects.     

Clonazepam in the treatment of labile arterial hypertension in the elderly]

AIM: To investigate effectiveness of clonazepam and its influence on autonomic function. MATERIAL AND METHODS: 56 patients with LHE aged 67.0 + 6.3 years were examined. 50 of them were treated with clonazepam in daily dose 1-2 mg. Their results were compared with age and sex matched normotensive persons. The routine clinical examination, regular measurement of blood pressure (BP), psychological tests, investigation of heart rate variability and evoked cutaneous sympathetic potentials (ECSP) were made. These tests were performed before and after treatment with clonazepam. RESULTS: Clonazepam significantly reduced fluctuations of BP in 82.0% of patients with LHE: the fluctuation range of systolic BP was reduced 2 times, diastolic BP--1.6. At the same time clonazepam diminished the level of anxiety, heart rate variability with increasing normalized VLF (central influence) and lowering LF and HF (segmental sympathetic and parasympathetic influences). ECSP were characterized by slowing sympathetic conduction and reduction of ECSP amplitude. CONCLUSION: Clonazepam, by changing autonomic properties, leads to stabilization of blood pressure in most patients with LHE. It is recommended to use clonazepam in daily dose 1-2 mg in combination with conventional antihypertensive medications for prevention of excessive fluctuation of BP in patients with LHE.     

Strategies developed by the elderly for controlling arterial hypertension

We objectified to investigate facing strategies elaborated by old-aged people which were attacked by arterial hypertension, being participants of a self-helping group, in a therapeutic accompaniment. The facing mechanisms corresponded to faith in God, family support, occupational activities accomplishment, leisure activities and group participation. Some old-aged people mentioned the family structure as the sustentation pillar for a better therapeutic following, making the elaboration of adaptative answers possible. We concluded that, in spite of all the felt and referred losses, the old-aged people searched to active mechanisms that propitiate adaptative answers to the health-disease situation.     

The condition of vascular-thrombocyte hemostasis in the elderly with arterial hypertension

The aim of the study was to analyze the main parameters of vascular-thrombocyte hemostasis in patients with systolo-diastolic and isolated systolic arterial hypertension (SDAH and ISAH) aged over 65 years. The subjects were 201 elderly patients with AH. The study revealed that uncomplicated AH in the elderly was characterized by activation of vascular hemostasis and increase of thrombocyte aggregation ability, manifested by the increase of Willebrand factor level, the presence of spontaneous and irreversible aggregation, coincidence of the first and the second waves of aggregation, and intensification of aggregation in response to "moderate" and "strong" inductors. Unlike ISAH, uncomplicated SDAH in the elderly is characterized by noticeable prevalence of night-peakers in the day profile of arterial pressure, and is accompanied by more pronounced thrombocyte hyperfunction; this difference should be taken into account while administering disaggregation therapy.     

Antihypertensive effect of oral potassium aspartate supplementation in mild to moderate arterial hypertension.

BACKGROUND: Previous studies showed that potassium chloride (48-120 mmol/day) supplementation reduced arterial blood pressure (BP) in hypertensive patients. OBJECTIVES: Our aim was to evaluate the effect of a lower dose of potassium aspartate salt on BP in individuals with essential arterial hypertension. METHODS: One hundred and four patients (65 males, age 53 +/- 12 years) with mild to moderate essential hypertension (systolic/diastolic BP 154.2/96.2 +/- 10.8/5.4 mmHg) were allocated in two comparable groups of 52 to receive or not 30 mmol/day per os of potassium aspartate supplementation for four weeks. Office and 24-h BP, as well as serum and urinary electrolytes, were measured at baseline and at the follow-up visit after four weeks. RESULTS: Office and 24-h BP did not change in the control group, while these values were significantly reduced in the potassium supplementation group. Changes in office (systolic BP: 154.4 +/- 8.2 vs. 142.2 +/- 7.6 mmHg; diastolic BP: 95.0 +/- 5.6 vs. 87.2 +/- 4.3 mmHg, P < 0.001 for both) and 24-h BP (systolic BP: 142.7 +/- 8.2 vs. 134.8 +/- 6.3 mmHg; diastolic BP: 90.8 +/- 4.4 vs. 84.6 +/- 3.8 mmHg, P < 0.001 for both) following potassium supplementation were highly significant. The changes in day time and night time BP were similar. The treated group showed significantly increased potassium serum level and 24-h urinary excretion of potassium (P < 0.01 in both cases) after four weeks, while the untreated group showed no significant changes of the same parameters. Urinary Na/K ratio decreased significantly with potassium supplementation (P < 0.001). In the treated group changes in office (r = 0.58, P < 0.001) and 24-h SBP (r = 0.51, P < 0.001), but not in DBP (r = 0.29 and r = 0.25, n.s.), correlated positively with the urinary Na/K ratio at baseline. CONCLUSIONS: A relatively low supplementation of 30 mmol/day of potassium as aspartate lowered office and 24-h ambulatory BP in subjects with mild to moderate essential hypertension. The antihypertensive effect was sustained throughout the day, and was greater in the patients with high basal urinary Na/K ratio.     

美托洛尔、尼卡地平对手术期间高血压患者心肌的保护作用

目的高血压患者因其本身的病理生理改变,手术期间心肌缺血损伤的发生率高于正常人,通过观察美托洛尔、尼卡地平干预对高血压患者非心脏手术前后心肌钙蛋白I(CTnI)的影响及心率血压变化,以探讨其对心肌的保护作用。方法选择ASAⅠ～Ⅱ级高血压病史5～20年择期行上腹部或胸部手术患者60例,采用抽签法随机分为对照组(Ⅰ)和美托洛尔(Ⅱ)、尼卡地平(Ⅲ)治疗组。在手术前后采静脉血,测心肌钙蛋白I同时观察围插管期心率血压变化。结果Ⅰ组术后CTnI浓度明显高于术前(F=126.79,P<0.01);而Ⅱ、Ⅲ组CTnI浓度术后轻度升高与手术前比较无统计学差异。心率血压方面插管即刻Ⅱ组、Ⅲ组与术前无明显变化与Ⅰ组比较有显著差异(F=19.26,P<0.01)。插管后5min,血压、心率基本平稳。结论美托洛尔、尼卡地平不但能有效抑制全麻诱导气管插管所致的心血管反应,而且对原发性高血压患者非心脏手术手术期间心肌缺血损伤也具有良好的保护作用。     

Hemodynamic effects of intravenous labetalol in essential hypertension

Labetalol inhibits alpha- and beta-adrenergic receptors. Systemic and regional hemodynamic alterations after intravenous labetalol and its cardiovascular reflexive and metabolic effects were evaluated in 12 subjects with mild to moderately severe essential hypertension. Supine systolic, diastolic, and mean pressures were reduced (from 180/101 and 125 to 149/86 and 109 mm Hg; P less than 0.001). The fall was accentuated during head-up tilt and was accompanied by decreased cardiac output and central blood volume in subjects in both the supine and tilted positions. Neither heart rate nor total peripheral resistance was changed by labetalol, suggesting that venodilation resulting from alpha-adrenergic-receptor inhibition played an important role in arterial pressure reduction.     

观察洛伐他汀对老年单纯收缩期高血压患者脉压及动脉弹性的影响

目的 观察他汀类药物对血脂正常的老年单纯收缩期高血压(ISH)患者脉压及动脉弹性的影响.方法 随机将68例ISH患者分成治疗组及对照组,对照组给予贝那普利口服,每次10 mg,1次/d;治疗组在对照组治疗基础上加用洛伐他汀,20 mg/次,每晚1次,观察两组患者治疗前后收缩压(SBP)、舒张压(DBP)、脉压(PP)、颈动脉-挠动脉脉博波速度(C-RPWV)及颈动脉-股动脉脉搏波速度(C-FPWV)的变化.结果 治疗后两组SBP、PP、C-RPW及CFPWV均有所下降,随着治疗时间的延长,治疗组较对照组PP、C-RPWV及C-FPWV显著降低(P<0.01).结论他汀类与血管紧张素转换酶抑制剂合用,有益于控制患者的脉压及脉搏波速度,改善动脉弹性.     

观察洛伐他汀对老年单纯收缩期高血压患者脉压及动脉弹性的影响

目的 观察他汀类药物对血脂正常的老年单纯收缩期高血压(ISH)患者脉压及动脉弹性的影响.方法 随机将68例ISH患者分成治疗组及对照组,对照组给予贝那普利口服,每次10 mg,1次/d;治疗组在对照组治疗基础上加用洛伐他汀,20 mg/次,每晚1次,观察两组患者治疗前后收缩压(SBP)、舒张压(DBP)、脉压(PP)、颈动脉-挠动脉脉博波速度(C-RPWV)及颈动脉-股动脉脉搏波速度(C-FPWV)的变化.结果 治疗后两组SBP、PP、C-RPW及CFPWV均有所下降,随着治疗时间的延长,治疗组较对照组PP、C-RPWV及C-FPWV显著降低(P<0.01).结论他汀类与血管紧张素转换酶抑制剂合用,有益于控制患者的脉压及脉搏波速度,改善动脉弹性.     

观察洛伐他汀对老年单纯收缩期高血压患者脉压及动脉弹性的影响

目的观察他汀类药物对血脂正常的老年单纯收缩期高血压（ISH）患者脉压及动脉弹性的影响。方法随机将68例ISH患者分成治疗组及对照组,对照组给予贝那普利口服,每次10mg,1次／d;治疗组在对照组治疗基础上加用洛伐他汀,20mg／次,每晚1次,观察两组患者治疗前后收缩压（SBP）、舒张压（DBP）、脉压（PP）、颈动脉一挠动脉脉博波速度（C-RPWV）及颈动脉．股动脉脉搏波速度（C-FPWV）的变化。结果治疗后两组SBP、PP、C—RPW及CFPWV均有所下降,随着治疗时间的延长,治疗组较对照组PP、C-RPWV及c-FPWV显著降低（P〈0．01）。结论他汀类与血管紧张素转换酶抑制剂合用,有益于控制患者的脉压及脉搏波速度,改善动脉弹性。     

观察洛伐他汀对老年单纯收缩期高血压患者脉压及动脉弹性的影响

目的 观察他汀类药物对血脂正常的老年单纯收缩期高血压(ISH)患者脉压及动脉弹性的影响.方法 随机将68例ISH患者分成治疗组及对照组,对照组给予贝那普利口服,每次10 mg,1次/d;治疗组在对照组治疗基础上加用洛伐他汀,20 mg/次,每晚1次,观察两组患者治疗前后收缩压(SBP)、舒张压(DBP)、脉压(PP)、颈动脉-挠动脉脉博波速度(C-RPWV)及颈动脉-股动脉脉搏波速度(C-FPWV)的变化.结果 治疗后两组SBP、PP、C-RPW及CFPWV均有所下降,随着治疗时间的延长,治疗组较对照组PP、C-RPWV及C-FPWV显著降低(P<0.01).结论他汀类与血管紧张素转换酶抑制剂合用,有益于控制患者的脉压及脉搏波速度,改善动脉弹性.     

Use of phisiotens for the treatment of arterial hypertension in elderly patients

AIM: To study effectiveness and safety of physiotens in elderly patients with essential hypertension (degree 1-2). MATERIAL AND METHODS: The trial enrolled 10 patients (6 males and 4 females) at the age of 60 to 75 years (mean age 66.4 +/- 3.7 years) with untreated or ineffectively treated essential hypertension (degree I-II by WHO classification). The disease stood for 17 +/- 5.3 years. Physiotens was given for 2 weeks in a single daily dose 0.2-0.4 mg. 24-h blood pressure monitoring, standard neuropsychological examination, echoCG, assessment of quality of life (Visual Analog Scale, Disability Scale) were performed before and after the treatment. RESULTS: Physiotens significantly reduced systolic and insignificantly diastolic pressure in daytime and at night; improved memory and thinking; 24 weeks of the treatment led to a decrease in left ventricular myocardium mass (by 13%, on the average) and in the thickness of left ventricular walls (by 7% on the average) as well as in life quality. CONCLUSION: Long-term physiotens treatment of elderly patients with mild and moderate hypertension provides a fall in day and night arterial pressure, regression of left ventricular myocardium mass, improves quality of life, memory and thinking.