Advertisement

Geriatric Cardiology and Blood Pressure

  • Edmund H. DuthieJr.
  • Michael H. KeelanJr.

Abstract

Degenerative disease of the cardiovascular system remains the leading cause of mortality and morbidity in the elderly patient. Coronary artery disease accounts for approximately 40% of all deaths beyond age 55 years.1 An impressive reduction in fatalities due to ischemic heart disease has been seen in the United States during the past 15 years. This favorable statistic applies to both sexes, whites and nonwhites, and patients over age 65 years as well. For white males age 65 to 74 years, the death rate from ischemic heart disease has fallen from 2119 per 100,000 in 1968 to 1642 per 100,000 in 1977.1 The decrease in mortality has not been accompanied by a comparable reduction in the incidence of coronary attacks (Fra-mingham study).2 Nonetheless, reduction in mortality does appear to be real and there are multifactoral explanations for it. Change in smoking habits, awareness of diet, better physical fitness, new pharmacologic agents, and coronary bypass all play a responsible role. Other therapeutic advances, particularly in the prevention and treatment of rheumatic fever and the surgical treatment of cardiac disease, have increased the lifespan of cardiac patients. Degenerative disease superimposed on preexisting valvular heart disease has resulted in an increasing population of elderly patients with “hybrid” heart disease. Appropriate therapy depends on early recognition of the underlying disease process and understanding its pathophysiology.

Keywords

Aortic Stenosis Orthostatic Hypotension Multiple System Atrophy Renal Artery Stenosis Systolic Hypertension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Levy, R. I. and Feinleib, M., 1980, Risk factors for coronary artery disease and their management in heart disease, in: Textbook of Cardiovascular Medicine (E. Braunwald, ed.), W. B. Saunders Company, Philadelphia, London, and Toronto, pp. 1246–1278.Google Scholar
  2. 2.
    Kannel, W. B. and Thorn, T. J., 1979, Implications of the recent decline in cardiovascular mortality, Cardiovasc. Med. 9:983–997.Google Scholar
  3. 3.
    Pomerance, A., 1976, Pathology of the myocardium and valves, in: Cardiology in Old Age (F. I. Caird, J. L. C. Dall, and R. D. Kennedy, eds.), Plenum Press, New York and London, pp. 11–55.Google Scholar
  4. 4.
    Lev, M., 1964, Anatomic basis for atrioventricular block, Am. J. Med. 37:742–747.PubMedGoogle Scholar
  5. 5.
    Dhingra, R. C., Amat-y-Leon, F., Pietras, R. J., Wyndham, C., Deedwania, P. G., Wu, D., Denes, P., and Rosen, K. M., 1977, Sites of conduction disease in aortic stenosis, Ann. Intern. Med. 87:275–280.PubMedGoogle Scholar
  6. 6.
    Bader, H., 1967, Dependence of wall stress in the human thoracic aorta on age and pressure, Circ. Res. 20:354–361.PubMedGoogle Scholar
  7. 7.
    Gribbin, B., Pickering, T. G., Steight, P., and Peto, R., 1971, Effect of age and high blood pressure on baroreflex sensitivity in man, Circ. Res. 29:424–431.PubMedGoogle Scholar
  8. 8.
    Strandell, T., 1976, Cardiac output in old age, in: Cardiology in Old Age (F. I. Caird, J. L. C. Dall, and R. D. Kennedy, eds.), Plenum Press, New York and London, pp. 81–100.Google Scholar
  9. 9.
    Bethel, C. S. and Crow, E. W., 1963, Heart sounds in the aged, Am. J. Cardiol. 11:763–767.PubMedGoogle Scholar
  10. 10.
    Ostenberger, L. E., Goldstein, S., Khaja, F., and Lakier, J. B., 1981, Functional mitral stenosis in patients with massive mitral annular calcification, Circulation 64:472–476.Google Scholar
  11. 11.
    Kistler, J. P., Lees, R. S., Friedman, J., Pressin, M., Mohr, J. P., Roberson, G. S., and Ojemann, R. G., 1978, The bruit of carotid stenosis versus radiated basal heart murmurs differentiation by phonoangiography, Circulation 57:975–981.PubMedGoogle Scholar
  12. 12.
    Fisch, C., 1981, Electrocardiogram in the aged: An independent marker of heart disease? Am. J. Med. 70:4–6.PubMedGoogle Scholar
  13. 13.
    Chiang, B. N., Perlman, L. V., Ostrander, L. D., and Epstein, F. H., 1969, Relationship of premature systoles to coronary heart disease and sudden death in the Tecumseh Epidemiologic Study, Ann. Intern. Med. 70:1159–1166.PubMedGoogle Scholar
  14. 14.
    Camm, A. J., Evans, K. E., Ward, D. E., and Martin, A., 1980, The rhythm of the heart in active elderly subjects, Am. Heart J. 99:598–603.PubMedGoogle Scholar
  15. 15.
    Freisinger, G. C. and Smith, R. F., 1972, Correlation of electrocardiographic studies and artériographie findings with angina pectoris, Circulation 46:1173–1184.Google Scholar
  16. 16.
    Ellestad, M. H., 1975, Predictive implications, in: Stress Testing Principles and Practice, F. A. Davis Company, Philadelphia, pp. 157–176.Google Scholar
  17. 17.
    Okada, R. D., Boucher, C. A., Strauss, H. W., and Pohost, G. M., 1980, Exercise radionuclide imaging approaches to coronary artery disease. Am. J. Cardiol. 46:1188–1204.PubMedGoogle Scholar
  18. 18.
    Port, S., Cobb, F. R., Coleman, R. E., and Jones, R. H., 1980, The effect of age in left ventricular function at rest and during exercise, N. Engl. J. Med. 303:1131–1137.Google Scholar
  19. 19.
    Corbett, J. R., Dehmer, G. J., Lewis, S. E., Woodward, W., Henderson, E., Parkey, R. W., Blomqvist, C. G., and Willerson, J. T., 1981, The prognostic value of submaximal exercise testing with radionuclide ventriculography before hospital discharge in patients with recent myocardial infarction, Circulation 64:535–544.PubMedGoogle Scholar
  20. 20.
    Parkey, R. W., Bonté, F. J., Lewis, S. E., Buja, C. M., and Willerson, J. T., 1980, Acute myocardial infarct imaging using Technetium-99m pyrophosphate, in: Nuclear Cardiology for Clinicians (J. S. Soin and H. L. Brooks, eds.), Futura Publishing Company, Mt. Kisco, N.Y., pp. 133–150.Google Scholar
  21. 21.
    Davis, K., Kennedy, J. W., Kemp, H. G., Jr., Judkins, M. P., Gosselin, A. J., and Killip, T., 1979, Complications of coronary angiography from the collaborative study of coronary artery surgery (CASS), Circulation 59:1105–1112.PubMedGoogle Scholar
  22. 22.
    Mason, J. W. and Winkle, R. A., 1980, Accuracy of the ventricular tachycardia induction study for predicting long-term efficacy and inefficacy of antiarrhythmic drugs, N. Engl. J. Med. 303:1073–1077.PubMedGoogle Scholar
  23. 23.
    Pathy, M. S., 1967, Clinical presentation of myocardial infarction in the elderly, Br. Heart J. 29:190–199.PubMedGoogle Scholar
  24. 24.
    Epstein, S. E., Kent, K. M., Goldstein, R. E., Borer, J. S., and Rosing, D. R., 1979, Strategy for evaluation and surgical treatment of the asymptomatic or mildly symptomatic patient with coronary artery disease, Am. J. Cardiol. 43:1015–1025.PubMedGoogle Scholar
  25. 25.
    Jones, R. H., McEwan, P., Newman, G. E., Port, S., Rerych, S. K., Scholz, P. M., Upton, M. T., Peter, C. A., Austin, E. H., Leong, K., Gibbons, R. J., Cobb, F. R., Coleman, R. E., and Sabiston, D. C., Jr., 1981, Accuracy of diagnosis of coronary artery disease by radionuclide measurement of left ventricular function during rest and exercise, Circulation 64:586–601.PubMedGoogle Scholar
  26. 26.
    Beta Blocker Heart Attack Study Group, 1981, The beta-blocker heart attack trial, JAMA 246:2073–2074.Google Scholar
  27. 27.
    Norwegian Multicenter Study Group, 1981, Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction, N. Engl. J Med. 304:801–807.Google Scholar
  28. 28.
    Frishman, W. H., 1981, Beta adrenoceptor antagonists: New drugs and new indications, N. Engl. J. Med. 305:500–506.PubMedGoogle Scholar
  29. 29.
    Antman, E. M., Stone, P. H., Muller, J. E., and Braunwald, E., 1980, Calcium channel blocking agents in the treatment of cardiovascular disorders. Part I: Basic and clinical electrophysiologic effects, Ann. Intern. Med. 93:875–885.PubMedGoogle Scholar
  30. 30.
    Stone, P. H., Antman, E. M., Muller, J. E., and Braunwald, E., 1980, Calcium channel blocking agents in the treatment of cardiovascular disorders. Part II: Hemodynamic effects and clinical applications, Ann. Intern. Med. 93:886–904.PubMedGoogle Scholar
  31. 31.
    Kawai, C., Konishi, T., Matsuyama, E., and Okazaki, H., 1981, Comparative effects of three calcium antagonists—diltiazem, verapamil, nifedipine—on sinoatrial and atrioventricular nodes, Circulation 63:1035–1042.PubMedGoogle Scholar
  32. 32.
    Proceedings of the Workshop on Platelet Active Drugs in the Secondary Prevention of Cardiovascular Events, 1980, Circulation 62(Suppl):V1–V135.Google Scholar
  33. 33.
    Jolly, W. W., Isch, J. H., and Schumacker, H. R., 1981, Cardiac surgery in the elderly, in: Cardiovascular Clinics, Volume 12, Number 2 (R. J. Noble and D. A. Rothbaum, eds.), F. A. Davis Company, Philadelphia, pp. 195–210.Google Scholar
  34. 34.
    Rahimtoola, S. H., Grunkemeier, G., Tepley, J., Lambert, L., Thomas, D. R., Yuen-Fure, S., and Starr, A., 1981, Changes in coronary bypass surgery leading to improved survival, JAMA 246:1912–1916.PubMedGoogle Scholar
  35. 35.
    Kennedy, J. W., Kaiser, G. C., Fischer, L. D., Fritz, J. K., Myers, W., Mudd, J. G., and Ryan, T. J., 1981, Clinical and angiographic predictors of operative mortality from collaborative study in coronary artery (CASS), Circulation 63:793–802.PubMedGoogle Scholar
  36. 36.
    Cines, D. B., Kaywin, P., Bina, M., Tomaski, A., and Schrieber, A. D., 1980, Heparin associated thrombocytopenia, N. Engl. J. Med. 303:788–795.PubMedGoogle Scholar
  37. 37.
    Miller, D. H. and Borer, J. S., 1982, Exercise testing early after myocardial infarction, Am. J. Med. 72:427–438.PubMedGoogle Scholar
  38. 38.
    Pomerance, A., 1965, Pathology of the heart with and without cardiac failure in the aged, Br. Heart J. 27:697–709.PubMedGoogle Scholar
  39. 39.
    Schlatmann, T. J. M. and Becker, A. E., 1977, Histologic changes in the normal aging aorta: Implications for dissecting aortic aneurysm, Am. J. Cardiol. 39:13–20.PubMedGoogle Scholar
  40. 40.
    Wheat, M. W., 1979, Treatment of dissecting aneurysms of the aorta: Current status, Prog. Cardiovasc. Dis. 16:87–101.Google Scholar
  41. 41.
    Finegan, R. E., Gianelly, R. E., and Harrison, D. C., 1969, Aortic stenosis in the elderly. Relevance of age to diagnosis and treatment, N. Engl. J. Med. 281:1261 – 1264.Google Scholar
  42. 42.
    Glancy, L., Freed, T. A., O’Brien, K. P., and Epstein, S., 1969, Calcium in the aortic valve-roentgenographic and hemodynamic correlations in 148 patients, Ann. Intern. Med. 71:246–250.Google Scholar
  43. 43.
    Wann, L. S. and Dillon, J. C., 1978, Echocardiography of the aortic valve, in: Handbook of Clinical Ultrasound (M. DeVlieger, ed.), John Wiley and Sons, New York, pp. 453–463.Google Scholar
  44. 44.
    Wagner, S. and Selzer, A., 1980, Natural history of unoperated aortic stenosis: Hemodynamic progression, Am. J. Cardiol. 45:440 (Abstract).Google Scholar
  45. 45.
    Tresch, D. D., Siegel, R., Keelan, M. H., Jr., Gross, C. M., and Brooks, H. L., 1979, Mitral valve prolapse in the elderly, J. Am. Geriatr. Soc. 27:421–424.PubMedGoogle Scholar
  46. 46.
    Cooper, E. S., Cooper, J. W., and Schnabel, T. G., 1966, Pitfalls in the diagnosis of bacterial endocarditis, Arch. Intern. Med. 118:55–61.PubMedGoogle Scholar
  47. 47.
    Dhingra, R. C., Wyndham, C., Amat-y-Leon, F., Denes, P., Wu, D., Sridhar, S., Bustin, A. G., and Rosen, K. M., 1979, Incidence and site of atrioventricular block in patients with chronic bifascicular block, Circulation 59:238–246.PubMedGoogle Scholar
  48. 48.
    Rodstein, M., Wolloch, L., and Iuster, Z., 1979, The natural history of intraventricular conduction disturbances in the aged: An analysis of the magnitude of risk of developing second and third degree heart block with clinical pathological correlations, Am. J. Med. Sci. 277:179–188.PubMedGoogle Scholar
  49. 49.
    McAnulty, J. H. and Rahimtoola, S. H., 1981, Chronic bundle branch block— clinical significance and management, JAMA 246:2202–2204.PubMedGoogle Scholar
  50. 50.
    Ruberman, W., Weinblatt, E., Goldberg, J. D., Frank, C. W., and Shapiro, S., 1977, Ventricular premature beats and mortality after myocardial infarction, N. Engl. J. Med. 297:750–757.PubMedGoogle Scholar
  51. 51.
    DiMarco, J. P., Garan, H., Harthorne, J. W., and Ruskin, J. N., 1981, Intracardiac electrophysiologic techniques in recurrent syncope of unknown cause, Ann. Intern. Med. 95:542–548.PubMedGoogle Scholar
  52. 52.
    Lovett, J. L., Sandok, B. A., Giuliani, E. R., and Nasser, F. N., 1981, Two-dimensional echocardiography in patients with focal cerebral ischemia, Ann. Intern. Med. 95:1–4.PubMedGoogle Scholar
  53. 53.
    Dodek, A., 1979, The serum digoxin test: A clinical perspective, Cardiol. Digest 14:19–24.Google Scholar
  54. 54.
    Keren, A., Tzivoni, D., Gavish, D., Levi, J., Gottlieb, S., Benhorin, J., and Stern, S., 1981, Etiology, warning signs, and therapy of Torsade de Pointes, Circulation 64:1167–1174.PubMedGoogle Scholar
  55. 55.
    Leahey, E. B., Jr., Reiffel, J. A., Drusin, R. E., Heissenbuttel, R. H., Lovejoy, W. P., and Bigger, J. T., 1978, Interaction between quinidine and digoxin, JAMA 240:533–534.PubMedGoogle Scholar
  56. 56.
    Feely, J., Wilkinson, G. R., and Wood, A. J. J., 1981, Reduction of liver blood flow and propranolol metabolism by Cimetidine. N. Engl. J. Med. 304:692–695.PubMedGoogle Scholar
  57. 57.
    Feely, J., Wilkinson, G. R., McAllister, C. B., and Wood, A. J. J., 1982, Increased toxicity and reduced clearance of lidocaine by Cimetidine, Ann. Intern. Med. 96:592–594.PubMedGoogle Scholar
  58. 58.
    Gohn, J. N. and Franciosa, J. A., 1977, Vasodilator therapy in cardiac failure, N. Engl. J. Med. 297:27–31, 254–258.Google Scholar
  59. 59.
    Weber, K. T., 1982, New hope for the failing heart, Am. J. Med. 72:665–670.PubMedGoogle Scholar
  60. 60.
    Arkins, R., Smessaert, A. A., and Hicks, R. G., 1964, Mortality and morbidity in surgical patients with coronary artery disease, JAMA 190:485–488.PubMedGoogle Scholar
  61. 61.
    Goldman, L., Caldera, D. L., Southwick, F. S., Nussbaum, S. R., Murray, B., O’Malley, T. A., Goroll, A. H., Caplan, C. H., Nolan, J., Burke, D. S., Krogstad, D., Carabello, A. C., and Slater, E. E., 1978, Cardiac risk factors and complications in noncardiac surgery, Medicine 57:357–370.PubMedGoogle Scholar
  62. 62.
    Harken, D. E., 1977, Malnutrition: A poorly understood surgical risk factor in aged cardiac patients, Geriatrics 32:83–85.PubMedGoogle Scholar
  63. 63.
    Skinner, J. F. and Pearce, M. L., 1964, Surgical risk in the cardiac patient, J. Chronic. Dis. 17:57–72.PubMedGoogle Scholar
  64. 64.
    Tarhan, S., Moffitt, E. A., Taylor, W. F., and Giuliani, E. R., 1972, Myocardial infarction after general anesthesia, JAMA 220:1451–1454.PubMedGoogle Scholar
  65. 65.
    Bonchek, L. I., Olinger, G. N., Keelan, M. H., Jr., Tresch, D. D., and Siegel, R., 1977, Management of sudden coronary death, Ann. Thoracic Surg. 24:337–345.Google Scholar
  66. 66.
    American Heart Association Committee Report (E. L. Kaplan, Chairman), 1977, Prevention of bacterial endocarditis, Circulation 56(1):139A–143A.Google Scholar
  67. 67.
    Kirkendall, W. M. and Hammond, J. J., 1980, Hypertension in the elderly, Arch. Intern. Med. 140:1155–1161.PubMedGoogle Scholar
  68. 68.
    Niarchos, A. P. and Laragh, J. H., 1980, Hypertension in the elderly, Mod. Concepts Cardiovasc. Dis. 49:43–48.PubMedGoogle Scholar
  69. 69.
    Niarchos, A. P. and Laragh, J. H., 1980, Hypertension in the elderly. II. Diagnosis and treatment, Mod. Concepts Cardiovasc. Dis. 49:49–54.PubMedGoogle Scholar
  70. 70.
    Brest, A. N. and Majdan, J., 1981, Hypertension in the elderly, Cardiovasc. Clin. 12:161–168.PubMedGoogle Scholar
  71. 71.
    Young, J. B., Rowe, J. W., Pallotta, J. A., Sparrow, D., and Landsberg, L., 1980, Enhanced plasma norepinephrine response to upright posture and oral glucose administration in elderly human subjects, Metabolism 29:532–539.PubMedGoogle Scholar
  72. 72.
    Vestal, R., Wood, A. J. J., and Shand, D. G., 1979, Reduced beta-adrenoreceptor sensitivity in the elderly, Clin. Pharm. Ther. 26:181–186.Google Scholar
  73. 73.
    Tobian, L., 1979, Dietary salt (sodium) and hypertension, Am. J. Clin. Nutr. 32(Suppl 12):2659–2663.PubMedGoogle Scholar
  74. 74.
    Tobian, L., 1979, The relationship of salt to hypertension, Am. J. Clin. Nutr. 32(Suppl 12):2739–2748.PubMedGoogle Scholar
  75. 75.
    Weiffenbach, J. M., Baum, B. J., and Burghauser, R., 1982, Taste thresholds: Quality specific variation with human aging, J. Gerontol. 37:372–377.PubMedGoogle Scholar
  76. 76.
    Miall, W. E. and Lovell, H. G., 1967, Relation between change of blood pressure and age, Br. Med. J. 2:660–664.PubMedGoogle Scholar
  77. 77.
    Kannel, W. B., 1976, Blood pressure and the development of cardiovascular disease in the aged, in: Cardiology in Old Age (F. I. Caird, J. L. C. Dall, and R. D. Kennedy, eds.), Plenum Press, New York and London, pp. 143–175.Google Scholar
  78. 78.
    National Health Survey, 1975, Blood pressure of persons 18–74 years in United States from 1971–1972, National Center for Health Statistics, Rockville, Maryland.Google Scholar
  79. 79.
    Sinnet, P. F. and Whyte, H. M., 1973, Epidemiological studies in a total highland population—Tukisenta, New Guinea: Cardiovascular disease and relevant clinical, electrocardiographic, radiological, and biochemical findings. J. Chron. Dis. 26:265–290.Google Scholar
  80. 80.
    Truswell, A. S., Kennelly, B. M., Hansen, J. D. L., and Lu, R. B., 1972, Blood pressures of Kury bushmen in northern Botswanna, Am. Heart J. 84:5–12.PubMedGoogle Scholar
  81. 81.
    Dyer, A. R., Stamler, J., Shekelle, R. B., Schoenberger, J., and Farinaro, E., 1977, Hypertension in the elderly, Med. Clin. North Am. 61:513–529.PubMedGoogle Scholar
  82. 82.
    Kennedy, R. D., 1976, High blood pressure and its management, in: Cardiology in Old Age, (F. I. Caird, J. L. C. Dall, and R. D. Kennedy, eds.), Plenum Press, New York and London, pp. 177–190.Google Scholar
  83. 83.
    Spence, J. D., Sibbald, W. J., and Cape, R. D., 1978, Pseudohypertension in the elderly, Clin. Sci. Mol. Med. 59:399s–402s.Google Scholar
  84. 84.
    Caird, R. I., Andres, G. R., and Kennedy, R. D., 1973, Affect of posture on blood pressure in the elderly, Br. Heart J. 35:527–530.PubMedGoogle Scholar
  85. 85.
    Dollery, C., Fagard, R., Forette, F., Hellemans, J., Lund-Johnsen, P., Mutsers, A., and Tuomilehto, J., 1978, Glucose intolerance during diuretic therapy: Results from the European Working Party on High Blood Pressure in the Elderly trial, Lancet 1:681–683.PubMedGoogle Scholar
  86. 86.
    Whitehouse, W. M., Kazmers, A., Zelenviu, G., Erlandson, E., Cronenwett, J., Lindenaver, S., and Stanley, J. C., 1981, Chronic total renal artery occlusion— Effects of treatment on secondary hypertension and renal function, Surgery 89:753–763.PubMedGoogle Scholar
  87. 87.
    Grim, E. E., Luft, F. C., Yune, H. Y., Klatte, E., and Weinberger, M., 1981, Percutaneous transluminal dilatation in the treatment of renal vascular hypertension, Ann. Intern. Med. 95:439–442.PubMedGoogle Scholar
  88. 88.
    Brown, J., 1982, Digital subtraction arteriography of the abdomen with emphasis on renal vasculature, in: Digital Subtraction Arteriography and Application of Computerized Fluoroscopy (C. Mistretta, A. Crummy, C. Strother, and J. Sackett, eds.), Year Book Medical Publishers, Inc., Chicago, pp. 69–73.Google Scholar
  89. 89.
    Madias, N. E., Kwon, O. J., and Millan, V. G., 1982, Percutaneous transluminal angioplasty: A potentially effective treatment for preservation of renal function, Arch. Intern. Med. 142:693–697.PubMedGoogle Scholar
  90. 90.
    Messerli, F. H., Fröhlich, E. D., Suarez, D. H., Reisin, E., Dreslinski, G., Dunn, F., and Cole, F., 1981, Borderline hypertension: Relationship between age, hemodynamics, and circulating calectrolamines, Circulation 64:760–764.PubMedGoogle Scholar
  91. 91.
    Lake, C. R., Ziegler, M. G., Coleman, M. D., and Kopin, I. J., 1977, Age-adjusted plasma norepinephrine levels are similar in normotensive and hypertensive subjects, N. Engl. J. Med. 296:208–209.PubMedGoogle Scholar
  92. 92.
    Mandai, T., Ogihara, T., Hata, T., Okada, T., Ogasahara, S., Nikami, H., Nakamaru, M., and Kumahara, Y., 1980, Urinary catecholamine response to glucagon in young and elderly patients with essential hypertension, J. Am. Geriatr. Soc. 28:462–465.PubMedGoogle Scholar
  93. 93.
    Takeda, R., Morimoto, S., Uchida, K., Miyamori, I., and Hashiba, T., 1980, Effect of age on plasma aldosterone response to exogenous angiotensin II in nor-motensive subjects, Acta Endocrinol. 94:552–558.PubMedGoogle Scholar
  94. 94.
    Morimoto, S., Uchida, K., Miyamoto, M., Kigoshi, T., Morise, T., Takimoto, H., and Takeda, R., 1981, Plasma aldosterone response to angiotensin II in sodium-restricted elderly subjects with essential hypertension, J. Am. Geriatr. Soc. 29:302–307.PubMedGoogle Scholar
  95. 95.
    Ogihara, T., Hata, T., Maruyama, A., Mikami, M., Nakamaru, M., Mandai, T., and Kumahara, Y., 1979, Studies on the renin-angiotensin-aldosterone system in elderly hypertensive patients with angiotensin II antagonist, Clin. Sci. 57:461–463.PubMedGoogle Scholar
  96. 96.
    Naka, T., Ogihara, T., Hata, T., Maruyama, A., Mikami, H., Nakamaru, M., Gotoh, S., Masuo, K., Ohde, H., Iwanaga, K., and Kumahara, T., 1981, The effect of aging on urinary kallikrein excretion in normotensive subjects and in patients with essential hypertension, J. Clin. Endocrinol. Metab. 52:1023–1026.PubMedGoogle Scholar
  97. 97.
    Koch-Weser, J., 1979, Treatment of hypertension in the elderly, in: Drugs and the Elderly, (J. Crooks and I. H. Stevenson, eds.), University Park Press, Baltimore, pp. 247–262.Google Scholar
  98. 98.
    Gifford, R., 1982, Isolated systolic hypertension in the elderly: Some controversial issues, JAMA 247:781–785.PubMedGoogle Scholar
  99. 99.
    Chobanian, A. V., 1981, Therapeutic decision making in systolic hypertension, Geriatrics 36(3):36–41.PubMedGoogle Scholar
  100. 99a.
    The Joint National Committee in Detection, Evaluation, and Treatment of High Blood Pressure, 1980, The 1980 report of The Joint Committee in Detection, Evaluation, and Treatment of High Blood Pressure, Arch. Intern. Med., 140:1280–1285.Google Scholar
  101. 100.
    Five year findings of the Hypertension Detection and Follow-up Program. I. Reduction in mortality of persons with high blood pressure including mild hypertension, 1979, JAMA 242:2562–2571.Google Scholar
  102. 101.
    Five year findings of the Hypertension Detection and Follow-up Program. II. Mortality by race, sex, and age, 1979. JAMA 242:2572–2577.Google Scholar
  103. 102.
    Libow, L. and Butler, R. N., 1981, Treating mild diastolic hypertension in the elderly: Uncertain benefits and possible dangers, Geriatrics 36(11):55–62.PubMedGoogle Scholar
  104. 103.
    Amery, A. and DeSchaepdryver, A., 1973, European Working Party on High Blood Pressure in the Elderly (EWPHE). Organization of double-blind multicentre trial on antihypertensive therapy in elderly patients, Clin. Sci. Mol. Med. 45:71s-73s.Google Scholar
  105. 104.
    Kuramoto, K., Matsushita, S., Kuwajima, I., and Mvrakami, M., 1981, Prospective study on the treatment of mild hypertension in the aged, Jap. Heart J. 22:75–85.PubMedGoogle Scholar
  106. 105.
    Parijs, J., Joossens, J. V., VanderLinden, L., Verstreken, G., and Amery, A., 1973, Moderate sodium restriction and diuretics in the treatment of hypertension, Am. Heart J. 85:22–34.PubMedGoogle Scholar
  107. 106.
    Reisin, E., Abel, R., Modan, M., Silverberg, D., Eliahou, H., and Modan, B., 1978, Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients, N. Engl. J. Med. 298:1–6.PubMedGoogle Scholar
  108. 107.
    Navarro, R., O’Brien, D. L., Nuffort, P., and Spencer, D. L., 1982, Diuretic induced hypokalemia in the elderly, J. Earn. Prac. 14:685–689.Google Scholar
  109. 108.
    Ouslander, J. G., 1981, Urinary incontinence in the elderly, West. J. Med. 135:482–491.PubMedGoogle Scholar
  110. 109.
    Messerli, F. H., Dreslinski, G. R., Husserl, R. E., Svarez, D., MacPhee, A., and Frohlich, E., 1981, Antiadrenergic therapy: Special aspects in hypertension in the elderly, Hypertension 3(Suppl. II):226–229.Google Scholar
  111. 110.
    Sotaniemi, E. A., Hukkanen, O. T., Akokas, J. T., Pelkonen, R. O., and Ahlqvist, J., 1977, Hepatic injury and drug metabolism in patients with alpha-methylodopa induced liver damage, Eur. J. Clin. Pharm. 12:429–435.Google Scholar
  112. 111.
    Castelden, G. M. and George, C. F., 1979, The effect of age on the hepatic clearance of propranolol, Br. J. Clin. Pharm. 7:49–54.Google Scholar
  113. 111a.
    Veteran’s Administration Cooperative Study Group on Antihypertensive Agents, 1967, Effects of treatment on morbidity in hypertension: Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg, JAMA 202:1028–1034.Google Scholar
  114. 112.
    Vidt, D. G., Bravo, E. L., and Fouad, F. M., 1982. Drug therapy—Captopril. N. Engl. J. Med. 306:214–219.PubMedGoogle Scholar
  115. 113.
    Thomas, J. E., Schirger, A., Fealey, R. D., and Sheps, S. G., 1981, Orthostatic hypotension, Mayo Clin. Proc. 56:117–125.PubMedGoogle Scholar
  116. 114.
    White, N. J., 1980, Heart rate changes on standing in elderly patients with orthostatic hypotension, Clin. Sci. 58:411–413.PubMedGoogle Scholar
  117. 115.
    Polinsky, R. J., Kopin, I. J., Ebert, M. H., and Weise, V., 1981, Phamacologic distinction of different orthostatic hypotension syndromes, Neurology (New York) 31:1–7.Google Scholar
  118. 116.
    Lake, C. R., 1979, Relationship of sympathetic nervous system tone and blood pressure, Nephron 23:84–90.PubMedGoogle Scholar
  119. 117.
    Management of orthostatic hypotension (Editorial), 1981, Lancet 2:963–964.Google Scholar
  120. 118.
    Ziegler, M. G., 1981, Choosing therapy for postural hypotension, Drug Ther. 10:97–114.Google Scholar
  121. 119.
    Bannister, R., 1979, Chronic autonomic failure with postural hypotension, Lancet ii:404–406.Google Scholar
  122. 120.
    Thomas, D. J. and Bannister, R., 1980, Preservation of autoregulation of cerebral blood flow in autonomic failure, J. Neurol. Sci. 44:205–212.PubMedGoogle Scholar
  123. 121.
    Schirger, A., Sheps, S. G., Thomas, J. E., and Fealey, R. D., 1981, Midodrine: A new agent in the management of idiopathic orthostatic hypotension and Shy-Dra-ger syndrome, Mayo Clin. Proc. 56:429–433.PubMedGoogle Scholar
  124. 122.
    Kochar, M. and Itskovitz, H., 1978, Treatment of idiopathic orthostatic hypotension (Shy-Drager syndrome) with indomethicin, Lancet i:1011–1014.Google Scholar
  125. 123.
    Jennings, G., Esler, M., and Holmes, R., 1979, Treatment of orthostatic hypotension with dihydroergotamine, Br. Med. J. 2:307.PubMedGoogle Scholar
  126. 124.
    Relman, A., 1980, Mild hypertension: No more benign neglect, N. Engl. J. Med. 302:293–294.PubMedGoogle Scholar
  127. 125.
    Kaplan, N. M., 1981, Whom to treat: The dilemma of mild hypertension, Am. Heart J. 101:867–870.PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1983

Authors and Affiliations

  • Edmund H. DuthieJr.
    • 1
    • 2
  • Michael H. KeelanJr.
    • 3
    • 4
  1. 1.Section of Geriatrics and Gerontology, Department of MedicineThe Medical College of WisconsinMilwaukeeUSA
  2. 2.Nursing Home Care UnitWood Veterans Administration Medical CenterWoodUSA
  3. 3.Section of Cardiology, Department of MedicineThe Medical College of WisconsinMilwaukeeUSA
  4. 4.Milwaukee County Medical CenterMilwaukeeUSA

Personalised recommendations