Isolated systolic hypertension in the elderly

@article{Chobanian2007IsolatedSH,
  title={Isolated systolic hypertension in the elderly},
  author={Aram V. Chobanian},
  journal={The New England Journal of Medicine},
  year={2007},
  volume={357},
  pages={789-796}
}
  • A. Chobanian
  • Published 23 August 2007
  • Medicine
  • The New England Journal of Medicine
Key MethodA 68-year-old accountant visits his physician. A year earlier he was told that his blood pressure was somewhat elevated and was advised to reduce salt intake and increase activity. Otherwise, he has been in good health and has no history or signs of cardiovascular or renal disease. On physical examination, his blood pressure is 178/72 mm Hg, and his body-mass index is 28.4. How should he be further evaluated and treated?
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HYPERTENSION IN ELDERLY:OUR CURRENT TRENDS
TLDR
A literature review of trials published in English in the last 10 years designed to study the effectiveness and safety of various BP targets in patients who are 70 years or older found that the benets in the positive studies were demonstrated even with a minimal BPcontrol and continued to be reported for a SBP<120 mmHg.
Hypertension Management in the Elderly: What is the Optimal Target Blood Pressure?
TLDR
A literature review of trials published in English in the last 10 years designed to study the efficacy and safety of various BP targets in patients who are 70 years or older found that the benefits in the positive studies were demonstrated even with a minimal BP control and continued to be reported for a SBP <120 mmHg.
General principles of hypertension management in the elderly.
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TLDR
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Clinicians should have a BP goal of less than 130/80 mm in all elderly patients with hypertension and DM, especially in those with high CV-risk, and when medications are required for optimal BP control in addition to lifestyle measures, either thiazide diuretics, angiotensin-converting-enzyme inhibitors, ang Elliotensin receptor blockers, or calcium channel blockers should be considered as initial therapy.
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An age-differential association between SUA level and incident hypertension among Koreans is observed, which can be a trigger for hypertension through early vascular changes in the middle-aged population.
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TLDR
Despite being well controlled and normotensive control subjects at rest, ISH patients had high SBP responses to both dynamic and static exercises, which may constitute a risk for cardiovascular incidents.
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TLDR
The authors systematically review published studies to appraise the scientific and clinical evidence supporting the role of blood pressure control in elderly patients with isolated systolic hypertension, and to assess the influence of different drug treatment regimens on outcomes.
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TLDR
AT1 receptor antagonists represent an appropriate option for many elderly patients with hypertension, type 2 diabetes, heart failure, and/or left ventricular dysfunction, including potential for improved adherence, excellent tolerability profile with minimal first-dose hypotension, and a low incidence of adverse effects.
Recognition and Management of Hypertension in Older Persons: Focus on African Americans
TLDR
The evidence and current guideline recommendations for hypertension treatment in older African Americans are reviewed, including the rationale for continuing to recommend a SBP target of less than 140 mmHg in this population.
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References

SHOWING 1-10 OF 63 REFERENCES
BENEFITS AND POTENTIAL HARM OF LOWERING HIGH BLOOD PRESSURE
Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension)
The role of diastolic blood pressure when treating isolated systolic hypertension.
TLDR
It is reassuring that patients receiving treatment for ISH never perform worse than patients receiving placebo in terms of CVD events, and further studies need to determine whether excessively low DBP can be prevented by more careful titration of antihypertensive therapy while maintaining SBP control.
Effects of reduced sodium intake on hypertension control in older individuals: results from the Trial of Nonpharmacologic Interventions in the Elderly (TONE).
TLDR
A reduced sodium intake is a broadly effective, nonpharmacologic therapy that can lower BP and control hypertension in older individuals.
Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group.
  • Medicine
    JAMA
  • 1991
TLDR
In persons aged 60 years and over with isolated systolic hypertension, antihypertensive stepped-care drug treatment with low-dose chlorthalidone as step 1 medication reduced the incidence of total stroke by 36%, with 5-year absolute benefit of 30 events per 1000 participants.
Physician Role in Lack of Awareness and Control of Hypertension.
TLDR
Community physicians do not give equal weight to systolic blood pressure of greater than 140 mm Hg as to diastolic pressure of less than 90mm Hg in diagnosing hypertension and intensifying treatment, which is a major determinant of the current level of unawareness of hypertension and uncontrolled, known hypertension found in national surveys.
Reducing the Risk of Dementia: Efficacy of Long-Term Treatment of Hypertension
TLDR
In hypertensive men, the duration of the antihypertensive treatment is associated with a reduced risk for dementia and cognitive decline, which is similar to the normotensives.
Results of the pilot study for the Hypertension in the Very Elderly Trial
TLDR
The preliminary results support the need for the continuing main HYVET trial and it is possible that treatment of 1000 patients for 1 year may reduce stroke events by 19 (nine non-fatal), but may be associated with 20 extra non-stroke deaths.
Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial
Orthostatic hypotension predicts mortality in elderly men: the Honolulu Heart Program.
TLDR
Orthostatic hypotension is relatively uncommon, may be a marker for physical frailty, and is a significant independent predictor of 4-year all-cause mortality in this cohort of elderly ambulatory men.
...
1
2
3
4
5
...