Systolic hypertension: hemodynamic mechanism and choice of antihypertensive treatment.

Arterial compliance and indexes of ventricular ejection were measured in 27 men with systolic hypertension. The patients were separated into two age groups, younger or older than age 35 years, and matched with normotensive control subjects. Arterial compliance was estimated from analysis of the monoexponential blood pressure-time curve during diastole, according to a simple viscoelastic model. In the younger patients, arterial compliance and stroke volume were within normal ranges. Rapid ejection time was significantly reduced (P less than 0.001), indicating an increased venlocity in the first part of ventricular ejection. Systolic pressure decreased significantly after administration of propranolol, which also caused prolongation of rapid ejection time. In the older patients, indexes of ventricular ejection were within normal limits. arterial compliance was significantly reduced (P less than 0.01) and was negatively correlated with the level of systolic pressure (P less than 0.001). Systolic pressure decreased significantly after administration of sodium nitroprusside, which caused an increase in arterial compliance. These findings provide evidence that: (1) the hemodynamic mechanisms of systolic hypertension differ in younger and older patients, and (2) these hemodynamic differences should be taken into account when choosing drugs to decrease systolic pressure.     

Systolic time intervals in chronic hypertension: Alterations and response to treatment.

Systolic time interval studies were performed to evaluate left ventricular performance in 28 patients with untreated systemic hypertension but without clinical heart failure. The pre-ejection period (PEP) was significantly prolonged (p smaller than 0.001) and left ventricular ejectime time (LVET) was shortened (p smaller than 0.02) when compared to rate-corrected predicted values. The PEP/LVET ratio was abnormally high in 18 of the patients and the average ratio was 0.45 ( smaller than 0.001). Eleven patients with abnormal time intervals were restudied during treatment with antilypertensive drugs. The PEP/LVET raio decreased in ten and became normal in nine. The average ratio decreased from 0.49 to 0.41 (p smaller than 0.001), due to both shortening of PEP (p smaller than 0.02) and lengthening of LVET (p smaller than 0.001). These findings indicate that alterations in left ventricular function may occur commonly in chronic hypertension in the absence of clinical heart failure, and can be reversed with appropriate therapy. This technique may be useful in evaluating hypertensive patients and in determining the efficacy of treatment.     

Systolic hypertension: nonhomogeneous diseases.

Prospective studies have shown that systolic hypertension is associated with increased cardiovascular risk, but few physiologic studies have characterized the problem. Therefore, two groups of men (older and younger than 35 years) with systolic hypertension (systolic pressure 150 mm Hg or greater and diastolic pressure 95 mm Hg or less) were studied hemodynamically. The 13 younger patients demonstrated a hyperkinetic circulation manifested by a significantly increased heart rate, elevated left ventricular ejection rate and cardiac indexes and normal vascular resistance. The 13 older patients had a normal heart rate, significantly reduced cardiac and left ventricular ejection rate indexes, and increased vascular resistance with respect to the younger men with systolic hypertension and normotensive control subjects. Plasma volume was reduced only in the older patients (P less than 0.05). These data demonstrate that systolic hypertension should not be considered a homogeneous disease entity clinically or physiologically. The physiologic differences between the younger and older patients suggest that different mechanisms may be operative.     

Timor filariasis: epidemiologic and clinical features in a defined community.

The epidemiology of Timor filariasis was observed during a clinical and parasitologic survey of persons living in a remote village on the island of Flores, Southeast Indonesia. Infection and disease was distributed evenly throughout the community, which was in accord with the breeding and feeding habits of the only identified vector, Anopheles barbirostris. Although micfofilaremia rates appeared independent of host variables of age and sexes and sex, symptoms of disease were greater among males than females, and in both sexes disease rates more than doubled between the first and second decades of life. Symptoms included recurring episodes of inguinal and femoral lymphadenitis with retrograde lymphangitis and fever, abscesses of lymph glands or vessels along the path of the great sapheneous vein and its mae highest yet reported for the Timor filaria; it is a virulent parasite causing serious ill-health among the inhabitants of eastern Flores.     

Systolic hypertension in the elderly. Pathophysiology and management.

Isolated systolic hypertension occurs with increased prevalence in the elderly population. It is characterized by reduced vascular compliance, often combined with increased peripheral resistance. These changes are not specific to patients with systolic hypertension, occurring, perhaps to a lesser extent, in the normotensive aging population as well. Systolic hypertension is associated with a risk of cardiovascular morbidity and mortality that possibly exceeds that associated with systolic-diastolic hypertension. However, until the recent report of the Systolic Hypertension in the Elderly Program, the benefit of treatment of this population was undocumented. The Systolic Hypertension in the Elderly Program demonstrated that lowering of blood pressure with a diuretic, combined, when necessary, with a beta blocker, reduced the rate of myocardial infarction and stroke. Other agents may also be effective in lowering blood pressure, although their ability to reduce cardiovascular morbidity and mortality in this population remains to be documented. The results suggest that pharmacologic treatment be considered for patients older than 60 years whose systolic blood pressure remains above 160 mm Hg (with a diastolic pressure below 90 mm Hg). Whether treatment should be recommended for all patients with systolic hypertension, or, alternatively, for only those at higher risk for cardiovascular events, remains controversial.     

Gender differences in the treatment of hypertension: a community based study in Porto.

OBJECTIVES: To describe the use of antihypertensive drugs in a random sample of adults living in Porto, Portugal, and to identify gender differences in the treatment of hypertension. DESIGN: Observational, cross-sectional. PARTICIPANTS AND METHODS: Nine hundred and fifty-nine participants over 39 years of age, living in Porto, were selected by random digit dialing. For each subject, socioeconomic characterization, family and personal medical history, and information on antihypertensive treatment were obtained through a questionnaire. Blood pressure was measured on a single occasion, and a fasting blood sample was collected. Gender differences in the treatment of arterial hypertension and number and type of drugs were evaluated through the calculation of female:male proportion ratios and 95% confidence intervals (95% CI). RESULTS: Hypertension treatment was more frequent in women than in men (proportion ratio 1.40, 95% CI 1.15-1.72), although no differences were observed among hypertensives aware of their condition (proportion ratio 1.07, 95% CI 0.93-1.22). The female:male proportion ratios of treatment with one drug, fixed combination therapy and free combination therapy were 1.13 (95% CI 0.94-1.36), 0.83 (95% CI 0.34-2.01) and 0.76 (95% CI 0.49-1.19), respectively. In subjects treated with one drug the use of ACE inhibitors/AT-II antagonists was more frequent in men (proportion ratio 0.68, 95% IC 0.46-1.01) and treatment with diuretics higher in women (proportion ratio 1.83, 95% CI 1.04-3.23). In participants treated with combination therapy, ACE inhibitors/AT-II antagonists and diuretics were more frequently used by women and calcium channel blockers and beta-blockers by men (female:male proportion ratios were 1.27, 95% CI 0.96-1.68, 1.24, 95% CI 0.94-1.64, 0.61, 95% CI 0.37-1.02 and 0.74, 95% CI 0.31-1.79, respectively). CONCLUSIONS: Arterial hypertension tended to be more frequently treated among women and different therapeutic options were found according to gender. Gender differences in the awareness of hypertension, sexual specificity of the activity of antihypertensive drugs, and comorbidity may play a role in gender inequalities in the treatment of hypertension in Portugal.     

Systolic hypertension. Direct and indirect BP measurements

The BPs of each of 26 patients with systolic hypertension were simultaneously measured indirectly by the cuff-mercury sphygmomanometer (cuff) and directly by intra-arterial recording from a brachial artery. The systolic BPs recorded by the two methods were comparable, indicating that systolic hypertension can be reliably diagnosed by readings from the cuff alone. However, the average diastolic BP was significantly overestimated by the cuff. This error in turn led to an underestimation by the cuff of the pulse pressure and overestimation of the mean arterial pressure. Thus, the low intra-arterial (true) diastolic BP and wide pulse pressure make increased arterial stiffness a plausible contributing factor in the pathophysiology of systolic hypertension.     

Systolic time intervals and echocardiographic findings in borderline hypertension.

Systolic time intervals, echocardiographic dimensions and hemodynamic parameters were determined in 42 borderline hypertensive patients with high cardiac output and 33 normal subjects. In borderline hypertensive patients, the preejection period was significantly reduced (P less than 0.001) and was negatively correlated to cardiac index (P less than 0.001). The interventricular septum thickness (IVS) was significantly increased (P less than 0.001) while the posterior wall thickness (PW) was within normal values. The IVS/PW ratio was significantly elevated (P less than 0.001) and was correlated negatively with the cardiac index (P less than 0.01) and positively with the preejection period (P less than 0.01). These findings suggest that (i) myocardial hypertrophy and increased left ventricular performance exist in borderline hypertension, (ii) myocardial contractility is reduced as myocardial hypertrophy increases.     

Systolic time intervals in essential hypertension. II. Variations produced by treatment with labetalol]

Characteristic changes in the systolic time intervals in Stage II (WHO Classification) hypertension have been demonstrated comprising an increase in the pre ejection period (PEP), a decrease in the left ventricular ejection time (LVET) both statistically significant, and an increase in the PEP/LVET ratio. We have studied the variations brought about by effective hypotensive therapy with an alpha and beta blocking agent (Labetalol) in 15 patients over a period of 90 days, with an average dosage of 420 mg/day in three divided doses. There was no significant variations in the PEP, but the LVET which had been reduced by 7.9% returned to within 2.8% of normal, with a reduction in the PEP/LVET ratio. The variations of these systolic indices (generally considered to be the most sensitive assessment of left ventricular function) seem to show that the hypotensive effect of labetalol is not related to a reduction in cardiac efficiency.     

Systolic hypertension and cardiac mortality of Takayasu's aortoarteritis.

Long-term observations of a 35-year-old woman who died from refractory congestive heart failure due to Takayasu's aortoarteritis are reported. Severe systolic hypertension was documented in the pre-pulseless phase. After the loss of all limb pulses, but relative sparing of carotid vessels, serial ophthalmodynamometric retinal pressures suggested that central aortic pressure remained high during her terminal cardiac illness. Postmortem pathologic examination showed a narrowed, severely atherosclerotic aorta with variable occlusions of all branch vessels. The loss of capacitance and volume of the aorta appears to be the cause of systolic hypertension and refractory pump failure of the left ventricle.     

老年收缩期高血压研究(SHEP)

标　　题　抗高血压药物对老年收缩期高血压患者脑卒中的预防作用,老年收缩期高血压研究最终结果作　　者　该项目协作研究组。　　参考文献　ＪＡＭＡ,1991,265,3255～3264研究的疾病　高血压病。目　　的　评估抗高血压药物对老年收缩期高血压患者脑卒中的预防作用。设　　计　随机、双盲、安慰剂对照、多中心研究。病人资料　4736例年龄≥60岁的患者,入选时收缩压160～219ｍｍＨｇ,舒张压<90ｍｍＨｇ,无心血管疾病及其他严重疾病史。入选患者随机分为治疗组(2365例)及对照组(2371例)。随　　访　平均4.5年。治疗方案　目标血压是原收缩压…     

Compliance to treatment for hypertension in elderly patients: the SHEP pilot study. Systolic Hypertension in the Elderly Program

Assessing the compliance of people over 60 years of age and older with an antihypertensive treatment regimen was a major objective of the Systolic Hypertension in the Elderly Program (SHEP) pilot study. The study randomized 551 men and women over the age of 60 (mean age = 72 years) to a stepped care treatment that included chlorthalidone or placebo in a double-blind trial. Three measures of compliance to treatment protocol--pill count, self-report, and a urine chlorthalidone assay--all indicated high levels of compliance in 80 to 90% of participants at 3 months and 1 year after randomization. Pill-taking compliance was similar in the active and placebo groups, although the rate of discontinuance from study medications at 1 year was higher in the placebo than in the active group. Compliance was high in all age categories, including those over age 80. These data suggest that elderly patients can achieve high levels of compliance with antihypertensive medications.