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PubMed2005

Plasma viscosity in isolated systolic hypertension: the role of pulse pressure.

Atherosclerosis is increasingly recognized as an inflammatory vascular disease, and high blood pressure (BP) has been suggested to exert a proinflammatory action. Whether plasma viscosity (PV), a major determinant of blood flow in microcirculation and a marker of systemic inflammation and cardiovascular risk, is increased in elderly subjects with isolated systolic hypertension is not known. In addition, the correlation of BP and its pulsatile component (ie, pulse pressure [PP]), with PV levels independent of the confounding effect of other cardiovascular risk factors has not been investigated. To this aim, we measured PV in 108 elderly men with never treated, uncomplicated isolated systolic hypertension, and in 60 healthy matched normotensive control subjects. The PV values were higher in hypertensive subjects than in controls (1.39+/-0.11 v 1.34+/-0.09 cP, P<.01). The PV showed a significant direct relation with both systolic BP (r=0.32) and PP (r=0.37, both P<.01), but not with diastolic BP (r=-0.03, P=.68). The PV was also directly associated with serum low-density lipoprotein cholesterol and triglycerides. In a multivariate analysis, PP was a significant predictor of PV levels when a consistent number of cardiovascular risk factors were simultaneously controlled for. In conclusion, PV is elevated in elderly subjects with isolated systolic hypertension. Systolic BP and PP appear to be major determinants of PV levels in these patients, independent of the potential proinflammatory action of traditional cardiovascular risk factors.

Aged↗
PubMed2005

Time course of diastolic and systolic function improvement after pulmonary valve replacement in adult patients with tetralogy of Fallot.

OBJECTIVES: The aim of this research was to assess right ventricular diastolic and systolic function before and after pulmonary valve replacement (PVR) in adult patients after repair of tetralogy of Fallot. BACKGROUND: Pulmonary valve replacement (PVR) in adult patients late after repair of tetralogy of Fallot leads to rapid improvement of right ventricular (RV) systolic function. METHODS: A total of 16 patients and 8 healthy subjects were included. Median age at initial repair was 4.9 (0.9 to 13.1) years, and mean age at PVR was 28.7 (19.5 to 45.6) years. Cardiac magnetic resonance imaging was performed before and 8 and 22 months after PVR. Right ventricular volumes and function as well as RV in- and outflow patterns were assessed. RESULTS: The volume of the early filling of the RV (Evol) increased from 49.8 +/- 14.7 ml to 53.8 +/- 19.3 ml (not significant) and 62.0 +/- 18.9 ml, respectively (p < 0.05), whereas the volume of the atrial contraction (Avol) remained unchanged. Consequently, the Evol/Avol ratio increased from 1.4 +/- 0.7 before PVR to 1.6 +/- 0.7 at 8 months (not significant) and 2.3 +/- 1.2 at 22 months (p < 0.01). The Evol/Avol ratio was not significantly different from the healthy subjects at 22 months, indicating late recovery of diastolic function. Systolic function improved rapidly after PVR; the indexed RV end-systolic volume decreased from 93.7 +/- 33.0 ml/m2 to 60.9 +/- 18.4 ml/m2 (p < 0.01) and 54.8 +/- 21.0 ml/m2 (p < 0.01). CONCLUSIONS: In adult patients late after total repair of Fallot, PVR leads to late improvement of diastolic function. We speculate that the rapid volume unloading after PVR increases systolic performance, whereas improvement in diastolic function requires long-term remodeling.

Adolescent↗
PubMed2001

Utility of B-natriuretic peptide levels in identifying patients with left ventricular systolic or diastolic dysfunction.

PURPOSE: Although echocardiography is important for making the diagnosis of left ventricular dysfunction, its cost and lack of availability limit its use as a routine screening test. B-Natriuretic peptide levels accurately reflect ventricular pressure, and preliminary studies with a rapid assay have found that levels are sensitive and specific for diagnosing heart failure in patients with dyspnea. We hypothesized that B-natriuretic peptide levels obtained through the use of a rapid assay should correlate with echocardiographic abnormalities of ventricular function. SUBJECTS AND METHODS: We studied 400 patients who were referred for echocardiography at the San Diego Veteran's Healthcare System between June and August 2000 to evaluate ventricular function. B-natriuretic peptide levels were measured by a point-of-care immunoassay; cardiologists assessing left ventricular function were blinded to the assay results. Patients were grouped into those with normal ventricular function, systolic dysfunction only, diastolic dysfunction only, and both systolic and diastolic dysfunction. RESULTS: Mean (+/- SD) B-natriuretic peptide concentration was 416 +/- 413 pg/mL in the 253 patients diagnosed with abnormal left ventricular function, compared with 30 +/- 36 pg/mL in the 147 patients with normal left ventricular function. Patients with both systolic and diastolic dysfunction had the highest levels (675 +/- 423 pg/mL). The area under the receiver operating characteristic (ROC) curve for B-natriuretic peptide levels to detect any abnormal echocardiographic finding was 0.95 (91% confidence interval: 0.93 to 0.97). B-Natriuretic peptide levels were unable to differentiate systolic vs. diastolic dysfunction. In patients with symptoms of heart failure and normal systolic function, B-natriuretic peptide levels >57 pg/mL had a positive predictive value of 100% for diastolic abnormalities. CONCLUSIONS: A simple, rapid test for B-natriuretic peptide levels can reliably predict the presence or absence of left ventricular dysfunction on echocardiogram. For some patients, a normal level may preclude the need for echocardiography.

Aged↗
PubMedDate not supplied

The systolic click-murmur syndrome: clinical recognition and management.

The midsystolic click-late systolic murmur syndrome is a complex entity with variable manifestations that involves a primary process causing myxomatous degeneration of the mitral valve leaflet(s) and subsequent systolic mitral valve leaflet prolapse. Other cardiac diseases may cause mitral valve prolapse and regurgitation associated with a midsystolic click that mimics this primary syndrome. The prolapsing mitral valve leaflet(s) syndrome occasionally may be familial. Most patients are asymptomatic but some complain of chest pain, palpitation, dyspnea or fatigue. Prolapsing mitral valve leaflet(s) can be distinguished from other causes of systolic clicks and mitral regurgitation murmurs by the characteristic movement of the clikmurmur complex in systole with various hemodynamic interventions. The clinical diagnosis usually can be confirmed by echocardiography, which demonstrates the abnormally prolapsdrome usually is minimal but can be progressive and lead to the need for prosthetic valve replacement. Most symptomatic patients can be managed medically but some require cardiac catheterization to evaluate the possibility of coexistent coronary artery disease, to assess the degree of mitral regurgitation and to evaluate other associated cardiac lesions. All patients with this syndrome should receive antibiotic prophylaxis prior to any surgical or dental procedures. Those patients suspected of having arrhythmias should be evaluated by continuous ambulatory ECG monitoring and dangerous arrhythmias probably should be treated. The prognosis usually is excellent, but sudden death and rapidly progressive mitral regurgitation due to ruptured chordae tendineae have been reported. Although more than a decade has elapsed since the midsystolic click-late systolic murmur syndrome was first recognized, much remains to be learned about this common but complex clinical entity.

Adolescent↗
PubMed1985

Doppler echocardiographic estimation of systolic pulmonary artery pressure in pediatric patients with interventricular communications.

The purpose of this study was to evaluate a noninvasive method for estimation of pulmonary artery pressures in infants and children with interventricular communications. Systolic pulmonary artery pressures measured by cardiac catheterization were compared with those estimated by Doppler echocardiography. Pressure drops were measured by Doppler study (modified Bernoulli equation) and were referenced to systolic systemic arterial pressure measured by sphygmomanometry. All 25 patients in this study had either a ventricular septal defect or a single ventricle. The systolic pulmonary artery pressure measured by cardiac catheterization ranged from 15 to 100 mm Hg (mean +/- SD 44 +/- 26) and that measured by Doppler echocardiography ranged from 5 to 100 mm Hg (mean 43 +/- 26) (p = NS; r = 0.92; SEE = 9.9; slope = 0.92; y intercept = 4.7). Systolic pulmonary artery to aortic pressure ratio measured by cardiac catheterization ranged from 0.2 to 1.0 (mean 0.5 +/- 0.3) and that measured by Doppler echocardiography ranged from 0.1 to 1.0 (mean 0.5 +/- 0.3) (p = NS; r = 0.94; SEE = 0.09; slope = 0.90; y intercept = 0.04). This study demonstrates that Doppler echocardiography can closely approximate systolic pulmonary artery pressure in patients with interventricular communications.

Blood Pressure↗
PubMed1986

Assessment of left ventricular end-systolic pressure-volume relations with an impedance catheter and transient inferior vena cava occlusion: use of this system in the evaluation of the cardiotonic effects of dobutamine, milrinone, Posicor and epinephrine.

The end-systolic pressure-volume relation has been postulated as a load-independent measure of cardiac contractility, but has been difficult to measure because of technical problems associated with the serial measurement of intracardiac volume over a physiologic range of ventricular loading conditions. Utilizing a multielectrode impedance catheter to assess continuous, on-line left ventricular relative volume during transient inferior vena cava occlusion, a method is described for determining the end-systolic pressure-volume relation and for assessing changes in this relation secondary to inotropic modulation. In particular, using this method, the relative inotropic properties were determined of four drugs: dobutamine, milrinone, epinephrine and an experimental cardiotonic agent (Ro 13-6438, Posicor). Left ventricular micromanometer pressure and impedance catheter volume were measured continuously in 10 open chest, anesthetized dogs and 14 pigs. Arterial pressure was altered over a range of 20 to 60 mm Hg by brief inferior vena cava constriction. A linear end-systolic pressure-volume relation was observed in pressure-volume diagrams constructed from on-line pressure and impedance catheter recordings. Administration of dobutamine, milrinone and epinephrine resulted in a leftward shift and an increase in the slope of the end-systolic pressure-volume relation as compared with baseline; Posicor did not alter the slope over a range of doses, despite an increase in the cardiac output secondary to arterial vasodilation. Volume changes as measured by the impedance method closely paralleled simultaneous changes in the ultrasonic crystal-determined segment length, and the impedance end-systolic pressure-volume relation slope was reproducible with repeated load-altering maneuvers.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

Frequency, prognosis and predictors of improvement of systolic left ventricular function in patients with 'classical' clinical diagnosis of idiopathic dilated cardiomyopathy.

In patients with dilated cardiomyopathy (DCM) of different aetiologies, a variable frequency of improvement in the left ventricular (LV) systolic function has been reported, while in patients with a 'classic' idiopathic DCM, the frequency of improvement is still under debate, and clinical and haemodynamic predictors of recovery of the LV function are needed. The aim of the present study was to determine the frequency of improvement in the LV systolic function in idiopathic DCM and to identify predictors of reversibility of the impaired LV contractility. A sample of 98 consecutive patients with idiopathic DCM was retrospectively evaluated. Echocardiographic and Doppler measurements were directly taken from the routine echo-report. LV systolic function was assessed semiquantitatively using a score index (SFSI). According to the improvement in the LV systolic function, the patients were divided into group 1 patients with improvement, and group 2 patients without improvement. During a follow-up of at least 12 months, 19 patients (19%) showed an improvement, with a significant increase in the mean SFSI; all these group 1 patients survived without heart transplant; in group 2, 18 patients (23%) died and 3 (4%) received a heart transplant. Patients in group 1 had a significantly shorter duration of symptoms (P=0.0045), a younger age (P=0.006), a shorter DtE (P=0.04), a lower SFSI (P<0.01), a worse NYHA class (P<0.001) and more frequently had a history of hypertension (P<0.0001). The same variables were significant predictors of improvement at the univariate analysis. At the multivariate logistic regression analysis, a shorter duration of symptoms (P=0.02), a history of hypertension (P=0.003), and a worse NYHA class (P=0.01) were independent predictors of improvement. A relatively large percentage of patients with an idiopathic DCM will have a marked improvement in the LV systolic function. This is more likely to happen in the presence of a short duration of symptoms and a history of hypertension. After an improvement, the prognosis is excellent.

Adult↗
PubMed2003

Lercanidipine vs lacidipine in isolated systolic hypertension.

This randomised, double-blind, double-dummy, parallel group, multicentre study compared the efficacy and tolerability of lercanidipine with lacidipine. Elderly patients with isolated systolic hypertension (supine blood pressure >/=160/<95 mmHg) were enrolled and underwent a placebo run-in period of 14-27 days before random allocation to lercanidipine tablets 10 mg once daily (n=111) or lacidipine tablets 2 mg once daily (n=111) for the assessment period (112-160 days). Titration to lercanidipine 20 mg once daily (two 10 mg tablets) or lacidipine 4 mg once daily (two 2 mg tablets) was allowed after 8 weeks, if required. Both treatments decreased supine and standing systolic and diastolic blood pressure between the end of the run-in period and the end of the assessment period (P<0.0001). At the end of the assessment period, the estimated mean treatment difference (95% confidence intervals) in supine systolic blood pressure was -0.81 (-4.45, 2.84) mmHg. These confidence intervals were within the limits specified for equivalence, that is, (-5, 5) mmHg. Ambulatory blood pressure monitoring showed that the antihypertensive effects of both drugs lasted for the full 24-h dosing period and followed a circadian pattern. Both treatments were well tolerated with a low incidence of adverse drug reactions and a low withdrawal rate. Significantly fewer patients withdrew from treatment with lercanidipine (P=0.015). Neither treatment had any clinically significant effect on pulse rate or cardiac conduction. In conclusion, both treatments were equally effective in controlling supine systolic blood pressure in patients with isolated systolic hypertension.

Aged↗
PubMed1975

Systolic blood pressure variation during the first 6 days of life.

1. Systolic blood pressure was measured by a Doppler ultrasound technique in twenty normal babies on 6 successive days after the day of delivery. In three babies blood pressure was recorded every 15 min for 24 h. 2. Systolic blood pressure during the first 6 days of life was 95 (SEM = 2) mmHg. 3. Systolic blood pressure increased on average by 2 mmHg/day, but increased most between the second and third days of life. 4. Systolic blood pressure was 11 mmHg higher when awake than when the babies were asleep. 5. There was marked within-baby variation in the systolic blood pressure of neonates, which could not be accounted for by age or recognizable changes in level in consciousness.

Age Factors↗
PubMed2002

Fetal growth and systolic blood pressure in young adulthood: the Swedish Young Male Twins Study.

The objective was to test the fetal origins hypothesis by examining the association between fetal growth and systolic blood pressure in a large cohort of adult male twins of known zygosity. This cohort study is based on a record linkage of routinely collected data from the Swedish Medical Birth Registry, the Swedish Military Conscription Registry and a mailed questionnaire. It comprises 886 pairs of same-sex male twins born in Sweden in 1973-79 for whom data were available on size at birth and systolic blood pressure, height and weight at age 17-19 years. Based on self-reported similarity of appearance in childhood, 384 twin pairs were classified as monozygotic (MZ), 269 as dizygotic (DZ) and 233 as of uncertain zygosity (XZ). Differences in systolic blood pressure within and between twin pairs were analysed in relation to birthweight and birthweight-for-gestational-age z-score using random effects linear models. Within twin pairs, a 1 kg difference in birthweight was associated with a difference of -1.30 mmHg in systolic blood pressure [95% confidence interval -4.15, +1.54] for MZ twins and +0.14 [-3.49, +3.76] for DZ twins; for all twins combined it was -0.21 [-2.13, +1.71]. Between twin pairs, a 1 kg difference in birthweight was associated with a difference of -2.68 mmHg in systolic blood pressure [-4.95, -0.42] for MZ twins and +0.28 [-2.35, +2.91] for DZ twins; for all twins combined -1.68 [-3.15, -0.22]. All these estimates included adjustment for age, year and conscription centre of examination, gestational age and height and weight at conscription. These results provide little support for the fetal origins hypothesis. The estimates of the within-pair effect in MZ twins and their wide confidence intervals (including zero) cannot exclude the existence of common genetic mechanisms, but are also not inconsistent with an in utero programming effect. This study highlights some methodological problems with twin studies.

Adolescent↗
PubMed2001

Effects of milrinone on left ventricular end-systolic pressure-volume relationship of rat hearts in situ.

1. We have already shown that the left ventricular (LV) end-systolic pressure-volume relationship (ESPVR) of rat hearts in situ is an upward convex curve and that LV end- systolic pressure (ESP(mLVV)) and the systolic pressure-volume area (PVA(mLVV)) at a mid-range LV volume (mLVV) sensitively reflect acute changes in LV contractility and work capability. Milrinone is a non-glycosidic, non-sympathomimetic drug that increases myocardial cAMP concentrations by selective inhibition of cardiac phosphodiesterase III. Therefore, milrinone could act on the entire cardiovascular system and cause an increase in inotropy, arterial vasodilatation and venodilatation. The aim of the present study was to investigate whether the approach we have recently instituted is able to detect the effects of milrinone on the entire cardiovascular system. 2. We measured simultaneously, in anaesthetized rats, continuous LV pressure using a catheter-tip micromanometer and LV volume by LV volumetry using a conductance catheter. We obtained steady state LV pressure-volume loops and intermittently obtained the LV ESPVR by gradual occlusion of the ascending aorta. We then evaluated LV function by assessing milrinone-induced changes in the ESPVR (i.e. ESP(mLVV) and PVA(mLVV)) and vasodilator actions by assessing milrinone-induced changes in ESP(ESV) and effective arterial elastance (Ea), defined as the ESP(ESV)/stroke volume ratio. 3. Milrinone (total dose 49.5 microg; infusion rate 3.3-6.7 microg/min, 7-10 microg/kg per min; blood concentration 53.9 ng/mL) largely shifted the ESPVR upwards and, thus, significantly increased end-systolic pressure (ESP(0.08)) and the systolic pressure-volume area (PVA(0.08)) at a mid-range LV volume (= 0.08 mL/g myocardium). Milrinone also significantly decreased LV ESP(ESV) and decreased Ea, although these decreases were not significant. 4. The results of the present study suggest that our own recently instituted approach to evaluate LV function by measuring LV pressure-volume loops and ESPVR succeeded in detecting a cardiotonic action of milrinone with arterial vasodilatation in normal rat hearts.

Animals↗
PubMed2000

Increased left ventricular mass index and nocturnal systolic blood pressure in patients with Type 2 diabetes mellitus and microalbuminuria.

AIMS: To compare left ventricular mass (LVM) index and function in patients with Type 2 diabetes mellitus with and without microalbuminuria and to investigate the clinical determinants of left ventricular hypertrophy. METHODS: Echocardiography, electrocardiography and 24-h ambulatory blood pressure monitoring were performed in microalbuminuric (n = 29) and normoalbuminuric (n = 29) patients with Type 2 diabetes and no clinical evidence of heart disease. Groups were individually matched for age, sex and diabetes duration and smoking status. RESULTS: LVM index (62 (34-87) vs. 52 (33-89) g/m2.7, P = 0.04) and LVH prevalence, using two out of three definitions, were greater in patients with microalbuminuria (LVM/height2.7: 72 vs. 59%, P = 0.27, LVM/height: 66 vs. 38%, P = 0.04, LVM/body surface area: 59 vs. 31%, P = 0.03). Night-time systolic blood pressure (126 (99-163) vs. 120 (104-157) mmHg, P = 0.005) and the night/day systolic blood pressure ratio (0.92 (0.08) vs. 0.88 (0.06), P = 0.04) were higher in those with microalbuminuria. Systolic and diastolic function were similar in both groups. Linear regression analyses showed that body mass index (BMI) was significantly related to loge LVM index (R2 = 11.8%, P = 0.005) and a relationship with night/day systolic blood pressure was also suggested (R2 = 4.6%, P = 0.057). CONCLUSIONS: In patients with Type 2 diabetes, LVH is more common and severe in those with microalbuminuria. Its presence may be related to raised night/day systolic blood pressure ratio and is significantly related to BMI. The high prevalence of LVH strengthens the case for echocardiographic screening in Type 2 diabetes to identify high risk patients who might benefit from aggressive cardiovascular risk factor intervention.

Aged↗
PubMed2002

Combined effects of systolic blood pressure and serum cholesterol on cardiovascular mortality in young (<55 years) men and women.

AIMS: To evaluate the combined effects of the two most frequent modifiable risk factors, systolic blood pressure and serum cholesterol, on cardiovascular and coronary mortality, in a large French population aged 18 to 55 years. METHODS AND RESULTS: We studied 108,879 men (mean age 39.1+/-9.4 years) and 84,931 women (mean age 37.3+/-10.0 years) who had a health check-up at the IPC Center between 1978 and 1988. Mortality data for a mean period of 13 years were analysed. Systolic blood pressure and cholesterol levels were classified according to the cut-points proposed by international guidelines. In men, the prevalence of high cholesterol was more than twice as high in hypertensives as in normotensives; in women, it was more than three times higher. The combination of these two risk factors has additive effects on cardiovascular disease and coronary heart disease risk. In men, a borderline elevation of both systolic blood pressure (130-139 mmHg) and cholesterol (200-239 mg x dl(-1)) leads to a three- to four-fold increase in cardiovascular disease risk. Men with systolic blood pressure >or=160 mmHg represent a small percentage (about 5%) who have a 10-fold increase in cardiovascular disease and coronary heart disease risk, especially when high cholesterol is present. In women of the same age, similar trends were observed, but the results were less significant, probably due to the low cardiovascular disease mortality rates. CONCLUSIONS: In conclusion, in French subjects under 55 years of age, a combination of high systolic blood pressure and high serum cholesterol dramatically increased cardiovascular disease and coronary heart disease risk, especially in men. A more aggressive public health policy is needed to prevent the development of risk factors in younger subjects.

Adult↗
PubMed2001

Several factors associated with the insulin resistance syndrome are predictors of left ventricular systolic dysfunction in a male population after 20 years of follow-up.

BACKGROUND: The epidemiologic data on heart failure are scarce. This study aimed at identifying predictors of left ventricular systolic dysfunction in a cohort of middle-aged men with a 20-year follow-up. METHODS: A population-based cohort of 431 50-year-old men was examined with blood pressure and anthropometric measurements together with lipid, glucose, and insulin determinations. A reinvestigation 20 years later also included echocardiography, ambulatory blood pressure monitoring, hyperinsulinemic euglycemic clamp, and oral glucose tolerance test. Sixteen subjects were found to have left ventricular systolic dysfunction at age 70 years, defined as an ejection fraction </=0.40. A control group of 48 subjects matched on myocardial infarction, hypertension, diabetes, and use of cardiovascular medication, but with an ejection fraction >0.40, was used in a nested case-control analysis. RESULTS: At age 50 years, heart rate (P <.01), plasma proinsulin (P <.05), and the proportion of dihomogammalinolenic acid in serum cholesterol esters (P <.05) were increased and serum phosphate decreased (P <.01) in the subjects identified with left ventricular systolic dysfunction at age 70 years compared with controls. No major metabolic abnormalities were associated with left ventricular systolic dysfunction at age 70 years compared with controls. CONCLUSION: Factors associated with insulin resistance precede left ventricular systolic dysfunction independently of ischemic heart disease and hypertension after 20 years of follow-up.

Age Factors↗
PubMed2004

Cardiovascular events in elderly patients with isolated systolic hypertension. A subgroup analysis of treatment strategies in STOP-Hypertension-2.

OBJECTIVE: To perform a subgroup analysis on those patients in STOP-Hypertension-2 who had isolated systolic hypertension. DESIGN AND METHODS: The STOP-Hypertension-2 study evaluated cardiovascular mortality and morbidity in elderly hypertensives comparing treatment with conventional drugs (diuretics, beta-blockers) with that of newer ones [angiotensin-converting enzyme (ACE) inhibitors, calcium antagonists]. In all, 6614 elderly patients with hypertension (mean age 76.0 years, range 70-84 years at baseline) were included in STOP-Hypertension-2. In the present subgroup analysis of STOP-Hypertension-2, isolated systolic hypertension was defined as systolic blood pressure at least 160 mmHg and diastolic blood pressure below 95 mmHg, in accordance with the Syst-Eur and Syst-China study criteria. In total, 2280 patients in STOP-Hypertension-2 met these criteria. In the study, patients were randomized to one of three treatment groups: "conventional" antihypertensive therapy with beta-blockers or diuretics (atenolol 50 mg, metoprolol 100 mg, pindolol 5 mg, or fixed-ratio hydrochlorothiazide 25 mg plus amiloride 2.5 mg daily); ACE inhibitors (enalapril 10 mg or lisinopril 10 mg daily); or calcium antagonists (felodipine 2.5 mg or isradipine 2.5 mg daily). Analysis was by intention to treat. RESULTS: The blood pressure lowering effect in patients with systolic hypertension was similar with all three therapeutic regimens: 35/13 mmHg in the conventional group (n=717), 34/12 mmHg in the ACE inhibitor group (n = 724), and 35/13 mmHg in the calcium antagonist group (n=708). Prevention of cardiovascular mortality, the primary endpoint of the study, did not differ between the three treatment groups. All stroke events, i.e. fatal and non-fatal stroke together, were significantly reduced by 25% in the newer-drugs group compared with the conventional group (95% CI 0.58-0.97; p=0.027). This difference was attributable to reduction of non-fatal stroke while fatal stroke events did not differ between groups. New cases of atrial fibrillation were significantly increased by 43% (95% CI 1.02-1.99; p=0.037) on "newer" drugs compared with "conventional" therapy, mainly attributable to the calcium antagonists. There were no significant differences between the three treatment groups with respect to the risks of myocardial infarction, sudden death or congestive heart failure. CONCLUSIONS: The analysis demonstrated that "newer" therapy (ACE inhibitors/calcium antagonists) was significantly better (25%) than "conventional" (diuretics/beta-blockers) in preventing all stroke in elderly patients with isolated systolic hypertension.

Adrenergic beta-Antagonists↗
PubMed1975

The clinical significance of systolic murmurs in the elderly.

A group of 278 patients, over the age of 60 years, and representative of geriatric and general medical admissions to the District General Hospital in Banbury, Oxforshire, was studied to correlate the prevalence of systolic murmurs to age, sex, cardiac failure, ischaemic heart disease, dysrrhythmias, hypertension, peripherial vascular disease and anaemia. The object was to establish the clinical significance of these murmurs and test a postulate that they could not be dismissed as benign. Seventy-five per cent of the murmurs were judged to be aortic and 12 per cent mitral in origin. The prevalence of systolic murmurs increased with age from 32 per cent at 60-64 years to 57 per cent over 85 years, and was greater in females (44 per cent) than in males (34 per cent). The presence of systolic murmurs was related to the presence of cardiac failure, ischaemic heart disease, dysrrhythmias, hypertension, peripheral vascular disease and anemia. Only 8 per cent of patients with systolic murmurs had none of the above-mentioned six cardiovascular abnormalities compared with 36 per cent of patients without such a murmur, while multiple cardiovascular abnormalities were also commoner in the former group. The mortality rate in hospital was similar for patients with or without a systolic murmur.

Age Factors↗
PubMed2000

Gestational age and growth rate of fetal mass are inversely associated with systolic blood pressure in young adults: an epidemiologic study of 165,136 Swedish men aged 18 years.

The objective of this study was to identify specific components of fetal growth that may underlie the observed association between birth weight and later blood pressure. A record linkage was made between the Swedish Medical Birth Registry, the Military Conscription Register, and censuses. For 165,136 men born in Sweden between 1973 and 1976 and conscripted from 1990 to 1996, systolic blood pressure was measured at age 18 years. Systolic pressure was independently inversely associated with birth weight for gestational age and with gestational age itself but not with birth length for gestational age. The difference in systolic pressure between the top and the bottom quintiles of birth weight for gestational age was -1.61 mmHg (95% confidence interval: -1.82 to -1.40) after adjustment for birth length for gestational age, height, and weight. The change in systolic pressure was -0.25 mmHg (-0.29 to -0.22) for a 1-week increase in gestational age. How far the inverse association of systolic pressure with length of gestation represents an independent effect of maturation is unclear. These findings help to refine the fetal origins hypothesis and provide further criteria against which potential biological mechanisms that link circumstances in utero to later blood pressure can be assessed.

Adolescent↗
PubMed1992

Discrepancies in recording systolic blood pressure of elderly persons by ambulatory blood pressure monitor.

Agreements between auscultatory blood pressure measurements and recordings of the Suntech Accutracker II ambulatory blood pressure monitor (ABPM) were examined in 103 participants ages 23 through 91 to estimate influence of age on accuracy of automated recordings. Simultaneous auscultation by two technicians and recording by the ABPM were compared. Technicians demonstrated close agreement in auscultation of blood pressure. Mean systolic blood pressure measured by ABPM was 5.6 mm Hg lower and mean ABPM diastolic blood pressure was 6.3 mm Hg lower than average auscultatory blood pressure measured by technicians (P less than .0001). Discrepancies in systolic blood pressure measurements between technicians and ABPM were associated with age and systolic blood pressure. The age effect, controlled for gender and race, was a 0.15 mm Hg increase in systolic blood pressure discrepancy per year of age. Discrepancies in diastolic blood pressure measurements were associated with race but not with age or body size measurements. Automated recordings of blood pressure by this ABPM may have systematic bias compared to auscultation which exceeds current standards for ABPM instrumentation. For systolic blood pressure, this bias increases with age and may affect interpretation of ABPM recordings in elderly persons.

Adult↗