BACKGROUND: In 1989, the European Working Party on High Blood Pressure in the Elderly started the double-blind, placebo-controlled, Systolic Hypertension in Europe Trial to test the hypothesis that antihypertensive drug treatment would reduce the incidence of fatal and nonfatal stroke in older patients with isolated systolic hypertension. This report addresses whether the benefit of antihypertensive treatment varied according to sex, previous cardiovascular complications, age, initial blood pressure (BP), and smoking or drinking habits in an intention-to-treat analysis and explores whether the morbidity and mortality results were consistent in a per-protocol analysis. METHODS: After stratification for center, sex, and cardiovascular complications, 4695 patients 60 years of age or older with a systolic BP of 160 to 219 mm Hg and diastolic BP less than 95 mm Hg were randomized. Active treatment consisted of nitrendipine (10-40 mg/d), with the possible addition of enalapril maleate (5-20 mg/d) and/or hydrochlorothiazide (12.5-25 mg/d), titrated or combined to reduce the sitting systolic BP by at least 20 mm Hg, to below 150 mm Hg. In the control group, matching placebo tablets were employed similarly. RESULTS: In the intention-to-treat analysis, male sex, previous cardiovascular complications, older age, higher systolic BP, and smoking at randomization were positively and independently correlated with cardiovascular risk. Furthermore, for total (P = .009) and cardiovascular (P = .09) mortality, the benefit of antihypertensive drug treatment weakened with advancing age; for total mortality (P = .05), the benefit increased with higher systolic BP at entry, while for fatal and nonfatal stroke (P = .01), it was most evident in nonsmokers (92.5% of all patients). In the perprotocol analysis, active treatment reduced total mortality by 24% (P = .05), reduced all fatal and nonfatal cardiovascular end points by 32% (P<.001), reduced all strokes by 44% (P = .004), reduced nonfatal strokes by 48% (P = .005), and reduced all cardiac end points, including sudden death, by 26% (P = .05). CONCLUSIONS: In elderly patients with isolated systolic hypertension, stepwise antihypertensive drug treatment, starting with the dihydropyridine calcium channel blocker nitrendipine, improves prognosis. The per-protocol analysis suggested that treating 1000 patients for 5 years would prevent 24 deaths, 54 major cardiovascular end points, 29 strokes, or 25 cardiac end points. The effects of antihypertensive drug treatment on total and cardiovascular mortality may be attenuated in very old patients.

Aged↗

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Distribution of blood pressure and prevalence of arterial hypertension in the old population of Cracow.

The aim of the present epidemiological study was to recognize the distribution of blood pressure (BP) and the prevalence of arterial hypertension (AH) in the aged (> or = 70 years) population in Cracow. The data were obtained from the studied group of 512 persons (153 men and 359 women) which corresponds to 72.4% of the randomly chosen group. The mean systolic BP was 159.7 in males and 164.3 mmHg in females (p < 0.05). Diastolic BP was 86.3 mmHg and 87.3 mmHg (n.s.), respectively. We observed the single peaked distribution of BP. According to the WHO epidemiological criteria of AH (BP > or = 160 = 95 mmHg) hypertension was found in 60.6% (49.7% M and 64.8% F) with systolic AH 32.3%, systolic+diastolic in 25.4% and diastolic AH alone in 2.9% of this group.

Aged↗

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The origins and development of gerontology in Poland.

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Geriatrics↗

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[Polycardiographic evaluation of left ventricular function in the elderly].

Polycardiographic recordings have been carried out in 57 individuals (16 men and 41 women), aged between 70 and 97 years (mean age 78.3 years), both at rest and during the stimulation of circulatory system by the cooling of hand. Systolic time intervals of the left ventricle and QT/QS2 ratio have been evaluated. It was found, that systolic time intervals at rest did not differ significantly from those given by Weissler. Cooling of hand has been manifested by: prolongation of LVETI, decrease in PEP/LVET, prolongation of QS2I, and decrease in QT/QS2. Results suggest indirectly that myocardium of the elderly adapts to the stimulation through Frank-Sterling mechanism.

Adaptation, Physiological↗

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[The state of the circulatory system in the elderly].

Fifty six persons (15 men and 41 women) aged between 90 and 99 years were examined to assess their health determining longevity. Circulatory system was evaluated with the aid of anamnesis, physical examination, chest X-ray and ECG. Clinical symptoms of the circulatory disease were diagnosed in 55.4% of tested persons, including: ischaemic heart disease in 42.9%, arterial hypertension in 35.7%, and circulatory failure in 23.2%. Normal ECG records were noted in 10.7% of the tested elderly persons. The most frequent electrographic abnormalities included: decrease in ST, LAH and atrio-ventricular block of the I degree. Incidence of ECG abnormalities did not depend upon the clinical state. An advanced age (over 90 years) is achieved also by the persons with marked circulatory disorders.

Aged↗

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Influence of Eraldin on some indices of atherogenesis.

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Adult↗

PubMedDate not supplied

[Use of nifedipine in elderly patients with essential hypertension: patient compliance, safety and efficacy of therapy].

The aim of the study was to evaluate chronic treatment with Cordafen (nifedipine) in the out-patients over 60 years of age with established arterial hypertension. Out of 100 out-patients aged 60-83 years 69 subjects completed one-year study. The main reasons of drop-outs were: lack of patient compliance (12%), severe side effects (11%), ineffective monotherapy (5%) and other (3%). Less severe adverse effects were found in further 20 subjects. After one-year therapy hematological and biochemical parameters of the homeostasis did not deteriorate except an increase in alkaline phosphatase. Regular drug intake in a dose of 20-80 mg/daily (mean = 46.0) produced a significant decrease in the blood pressure level and an improvement of cardiac function indices (CO nad EF). In contrast Cordafen did not reduce the differences between extreme blood pressure values recorded automatically, and it did not produce a significant regression of left ventricular mass and cardiac arrhythmias. Nifedipine in mild or moderate hypertension in the elderly patient any be an adequate form of monotherapy in about 70% of them. Higher motivation for treatment in this age group and better drug tolerance may further improve this efficacy.

Age Factors↗