Geriatric Cardiology and Blood Pressure

  • Edmund H. DuthieJr.
  • Michael H. KeelanJr.
Part of the Contemporary Geriatric Medicine book series (COGM, volume 3)


Degenerative disease of the cardiovascular system remains the leading cause of morbidity and mortality 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 65 years as well. For white males aged 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 A comparable reduction in the incidence of coronary attacks was not seen initially,2 but more recent data suggest that they too are decreasing in number.3 This reduction in mortality is real and there are multifactorial explanations for it. A change in smoking habits, awareness of diet, better physical fitness, newer pharmacologic agents, and interventions such as coronary bypass and angioplasty 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 an understanding of its pathophysiology. This task is made more difficult because the clinical history is often atypical or the physical signs are masked by the effects of aging on the cardiovascular system.


Aortic Stenosis Beta Blocker Renal Artery Stenosis Systolic Hypertension Total Peripheral Resistance 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  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, 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.
    Gillum, R. F. and Folsum, A. R., 1984, Decline in coronary heart disease mortality. Old questions and new facts. Am. J. Med. 76:1055–1065.PubMedGoogle Scholar
  4. 4.
    Pomerance, A., 1976, Pathology of the myocardium and valves, in: Cardiology in Old Age (F. L. Caird, J. L. C. Dall, and R. D. Kennedy, eds.). Plenum Press, New York, London, pp. 11–55.Google Scholar
  5. 5.
    Lev, M., 1964, Anatomic basis for atrioventricular block, Am. J. Med. 37:742–747.PubMedGoogle Scholar
  6. 6.
    Dhingra, R. C., Amaty-Leon, F., Pietras, R. J., Wyndham, C., Deedwania, P. C., WU, D., Denes, P., and Rosen, K. M., 1977, Sites of conduction disease in aortic stenosis, Ann. Intern. Med. 87:275–280.PubMedGoogle Scholar
  7. 7.
    Bader, H., 1967, Dependence of wall stress in the human thoracic aorta on age and pressure, Circ. Res. 10:354–361.Google Scholar
  8. 8.
    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
  9. 9.
    Strandeil, T., 1976, Cardiac output in old age, in: Cardiology in Old Age (F. L. Caird, J. L. C. Dall, and R. D. Kennedy, eds.). Plenum Press, New York, London, pp. 81–100.Google Scholar
  10. 10.
    Rodeheffer, R. J., Gerstenblith, G., Becker, L. C., Fleg, J. L., Weisfeldt, M. L., and Lakatta, E. G., 1984, Exercise cardiac output is maintained in healthy human subjects: cardiac dilatation and increased stroke volume compensated for in diminished heart rate.Circulation 69:203–212.PubMedGoogle Scholar
  11. 11.
    Bethel, C. S., and Crow, E. W., 1963, Heart sounds in the aged, Am. J. Cardiol. 11:763–767.PubMedGoogle Scholar
  12. 12.
    Wong, M., Tei, C., and Shah, P. M., 1983, Degenerative calcific valvular disease and systolic murmurs in the elderly, J. Am. Geriatr. Soc. 31:156–163.PubMedGoogle Scholar
  13. 13.
    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
  14. 14.
    Fisch, C., 1981, Electrocardiogram in the aged: an independent marker of heart disease? Am. J. Med. 70:4–6.PubMedGoogle Scholar
  15. 15.
    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 Epidemiologie Study, Ann. Intern. Med. 70:1159–1166.PubMedGoogle Scholar
  16. 16.
    Gamm, 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.Google Scholar
  17. 17.
    Freisinger, G. G., and Smith, R. F., 1972, Gorrelation of electrocardiographic studies and arteriographic findings with angina pectoris. Circulation 46:1173–1184.Google Scholar
  18. 18.
    Elles tad, M. H., 1975, Predictive implications, in: Stress Testing Principles and Practice, F. A. Davis, Philadelphia, pp. 157–176.Google Scholar
  19. 19.
    Okada, R. D., Boucher, G. 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
  20. 20.
    Boucher, G. A., Brewster, D. G., Darling, R. G., Okada, R. D., Strauss, H. W., and Pohost, G. M., 1985, Determination of cardiac risk by dipyrida- mole-thallium imaging before peripheral vascular surgery, N. Engl. J. Med. 312:389–394.PubMedGoogle Scholar
  21. 21.
    Port, S., Gobb, F. R., Goleman, 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
  22. 22.
    Hakki, A. H., DePace, N. L., and Iskandrian, A. S., 1983, Effect of age on left ventricular function during exercise in patients with coronary artery disease, JACC 2:645–651.PubMedGoogle Scholar
  23. 23.
    Gorbett, J. R., Dehmer, G. J., Lewis, S. E., Woodward, W., Henderson, E., Parkey, R. W., Blomqvist, G. 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.Google Scholar
  24. 24.
    Parkey, R. W., Bonte, F. J., Lewis, S. E., Buja, G. 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, Mt. Kisco, NY, pp. 133–150.Google Scholar
  25. 25.
    Falk, R. H., Lee, V. W., Rubinow, A., Hood, W. B., Jr., and Gohen, A. S., 1983, Sensitivity of technetium pyrophosphate scintigraphy in diagnosing cardiac amyloidosis, Am. J. Cardiol. 51:826–830.PubMedGoogle Scholar
  26. 26.
    Gibson, T. G., and Heitzman, M. R., 1984, Diagnostic efficacy of 24-hour electrocardiographic monitoring for syncope. Am. J. Cardiol. 53:1013–1017.PubMedGoogle Scholar
  27. 27.
    Gersh, B. J., Kronmal, R. A., Frye, R. L., Schaff, H. V., Ryan, T. J., Gosselin, A. J., Kaiser, G. G., Killip, T., III, and Participants in the Goro-nary Artery Surgery Study, 1983, Goronary arteriography and coronary artery bypass surgery: Morbidity and mortality in patients age 65 years or older. A report from the Goronary Artery Surgery Study, Circulation 67:483–491.PubMedGoogle Scholar
  28. 28.
    Mason, J. W., and Winkle, R. A., 1980, Accuracy of the ventricular tachycardia induction study for predicting long-term efficacy of antiarrhythmic drugs, N. Engl. J. Med. 303:1073–1077.PubMedGoogle Scholar
  29. 29.
    Pathy, M. S., 1967, Clinical presentation of myocardial infarction in the elderly, Br. Heart J. 29:190–199.PubMedGoogle Scholar
  30. 30.
    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
  31. 31.
    Hung, J., Goris, M. L., Nash, E., Kraemer, H. C., Debusk, R. F., Berger, W. E., III, and Lew, H., 1984, Comparative value of maximal treadmill testing, exercise Thallium myocardial perfusion scintigraphy, and exercise radionuclide ventriculography for distinguishing high- and low-risk patients soon after acute myocardial infarction. Am. J. Cardiol. 53:1221–1227.PubMedGoogle Scholar
  32. 32.
    The Multicenter Postinfarction Research Group, 1983, Risk stratification and survival after myocardial infarction, N. Engl. J. Med. 309:331–336.Google Scholar
  33. 33.
    Weiner, D. A., Ryan, T. J., McCabe, C. H., Chaitman, B. R., Sheffield, L. T., Ferguson, J. C., Fisher, L. D., and Tristani, F., 1984, Prognostic importance of a clinical profile and exercise test in medically treated patients with coronary artery disease, JACC 3:772–779.PubMedGoogle Scholar
  34. 34.
    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
  35. 35.
    Reichek, N., Priest, C., Zimrin, D., Chandler, T., and St. John Sutton, M., 1984, Antianginal effects of nitroglycerin patches. Am. J. Cardiol. 54:1–13.PubMedGoogle Scholar
  36. 36.
    Olivari, M. T., Carlyle, P. F., Levine, T. B., and Cohn, J. N., 1983, Hemodynamic and hormonal response to transdermal nitroglycerin in normal subjects and in patients with congestive heart failure, JACC 2:872–878.PubMedGoogle Scholar
  37. 37.
    Beta Blocker Heart Attack Study Group, 1981, The beta blocker heart attack trial, JAMA 246:2073–2074.Google Scholar
  38. 38.
    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
  39. 39.
    Frishman, W. H., 1981, Beta adrenoceptor antagonists: New drugs and new indications, N. Engl. J. Med. 304:500–506.Google Scholar
  40. 40.
    Ahumada, G. G., 1984, Identification of patients who do not require beta antagonists after myocardial infarction. Am. J. Med. 76:900–904.PubMedGoogle Scholar
  41. 41.
    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
  42. 42.
    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. 93:866–904.Google Scholar
  43. 43.
    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
  44. 44.
    Proceedings of the Workshop on Platelet Active Drugs in the Secondary Prevention of Cardiovascular Events, 1980, Circulation 62 (Suppl. V):l-135.Google Scholar
  45. 45.
    Lewis, H. D., Jr., Davis, J. W., Archibald, D. G., Steinke, W. E., Smither man, T. C., Doherty, J. E., III, Schnaper, H. W., LeWinter, M. M., Linares E., Pouget, J. M., Sabharwal, S. C., Chesler, E., and DeMots, H., 1983 Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina: Results of a Veteran’s Administration Coop erative Study. N. Engl J. Med. 309:396–403.PubMedGoogle Scholar
  46. 46.
    Cairns, J. A., Gent, M., Singer, J., Finnie, K. J., Froggatt, G. M., Holder, D A., Jablonsky, G., Kostuk, W. J., Melendez, L. J., Myers, M. G., Sackett, D L., Sealey, B. J., and Tanser, P. H., 1985, Aspirin, sulfinpyrazone, or both in unstable angina: Results of a Canadian Multicenter Trial, N. Engl. J Med. 313:1369–1375.PubMedGoogle Scholar
  47. 47.
    O’Neill, W., Timmis, G. C., Bourdillon, P. D., Lai, P., Ganghadarhan, V. Walton, J. Jr., Ramos, R., Laufer, N., Gordon, S., Schork, A., and Pitt, B. 1986, A prospective randomized trial of intracoronary streptokinase versus coronary angioplasty for acute myocardial infarction, N. Engl. J. Med. 314:812–818.PubMedGoogle Scholar
  48. 48.
    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
  49. 49.
    Miller, D. H., and Borer, J. S., 1982, Exercise testing early after myocardial infarction, Am. J. Med. 72:427–438.PubMedGoogle Scholar
  50. 50.
    Raizner, A. E., Hust, R. G., Lewis, J. M., Winters, W. L., Jr., Batty, J. W., and Roberts, R., 1986, Transluminal coronarx angioplasty in the elderly, Am. J. Cardiol. 59:29–32.Google Scholar
  51. 51.
    Jolly, W. W., Isch, J. H., and Schumacker, H. R., 1981, Cardiac surgery in the elderly, in: Cardiovascular Clinics, Vol. 12, Number 2 (R.J. Noble and D. A. Rothbaum, eds.), F. A. Davis, Philadelphia, pp. 195–210.Google Scholar
  52. 52.
    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 246:1912–1219.PubMedGoogle Scholar
  53. 53.
    Kennedy, J. W., Kaiser, G. C., Fisher, L. D., Eitz, 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
  54. 54.
    Pomerance, A., 1965, Pathology of the heart with and without cardiac failure in the aged, Br. Heart J. 27:697–709.PubMedGoogle Scholar
  55. 55.
    Topol, E. J., Traill, T. A., and Fortuin, N. J., 1985, Hypertensive hypertrophic cardiomyopathy of the elderly, N. Engl. J. Med. 312:277–283.PubMedGoogle Scholar
  56. 56.
    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
  57. 57.
    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.PubMedGoogle Scholar
  58. 58.
    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
  59. 59.
    Wann, L. S., and Dillon, J. C., 1978, Echocardiography of the aortic valve, in: Handbook of Clinical Ultrasound (M. De Vlieger, ed.), Wiley, New York, pp. 453–463.Google Scholar
  60. 60.
    Wagner, S., and Selzer, A., 1980, Natural history of unoperated aortic stenosis: Hemodynamic progression. Am. J. Cardiol. 45:440 (abstr.).Google Scholar
  61. 61.
    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
  62. 62.
    Kolibash, A. J., Bush, C. A., Fontana, M. B., Ryan, J. M., Kicman, J., and Wooley, C. F., 1983, Mitral valve prolapse syndrome: Analysis of 62 patients aged 60 years and older, Am. J. Cardiol. 52:534–539.PubMedGoogle Scholar
  63. 63.
    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
  64. 64.
    Cribier, A., Letac, B., Lancelin, B., Guermonprez, J. L., Traisnel, G., Machecourt, J., Virot, P., Drobinski, G., Commeau, P., and Vahanian, A., 1986, Percutaneous balloon valvuloplasty (PBV) for acquired aortic stenosis: Preliminary immediate results of the French Registry, Circulation 74(Suppl. II):208 (abstr.).Google Scholar
  65. 65.
    McKay, R. G., Safian, R. D., Lock, J. E., Diver, D. J., Berman, A. D., Warren, S. E., Come, P. C., Baim, D. S., Mandell, V. E., Royal, H. D., and Grossman, W., 1987, Assessment of left ventricular and aortic valve function after balloon valvuloplasty in adult patients with critical aortic stenosis. Circulation 75:192–203.PubMedGoogle Scholar
  66. 66.
    St. John Sutton, M. G. Tajik, A. J., and McGoon, D. C., 1981, Atrial septal defect in patients ages 60 years or older: Operative results and long-term post-operative follow-up. Circulation 64:402–409.Google Scholar
  67. 67.
    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
  68. 68.
    Rodstein, M., Wolloch, L., and Luster, 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
  69. 69.
    McAnulty, J. H., and Rahimtoola, S. H., 1981, Chronic bundle branch block—Clinical significance and management, JAMA 246:2202–2204.PubMedGoogle Scholar
  70. 70.
    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
  71. 71.
    Atrial Fibrillation and Stroke in the Elderly: The Framingham Study, 1985, Stroke 16:138 (abstr.).Google Scholar
  72. 72.
    Adams, P. C., Cohen, M., Chesebro, J. H., and Fuster, V., 1986, Thrombosis and embolism from cardiac chambers and infected valves, JACC 8:76B-87B.PubMedGoogle Scholar
  73. 73.
    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
  74. 74.
    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
  75. 75.
    Dodek, A., 1979, The serum digoxin test: A clinical perspective, Cardiol. Digest 14:19–24.Google Scholar
  76. 76.
    Mulrow, C. D., Feussner, J. R., and Velez, R., 1984, Re-evaluation of digitalis: Efficacy, new light on an old leaf, Ann. Intern. Med. 101:113–117.PubMedGoogle Scholar
  77. 77.
    Ware, J. A., Snow, E., Luchi, J. M., and Luchi, R. J., 1984, Effect of digoxin on ejection fraction in elderly patients with congestive heart failure, J. Am. Geriatr. Soc. 32:631–635.PubMedGoogle Scholar
  78. 78.
    Cohn, J. N., and Franciosa, J. A., 1977, Vasodilator therapy in cardiac failure, N. Engl. J. Med. 297:27–31 and 254–258.PubMedGoogle Scholar
  79. 79.
    Cohn, J. N., Archibald, D. G., Ziesche, S., Franciosa, J. A., Harston, W. E., Tristani, F. E., Dunkman, W. B., Jacobs, W., Francis, G. S., Flohr, K. H., Goldman, S., Cobb, F. R., Shah, P. M., Saunders, R., Fletcher, R. D., Loeb, H. S., Hughes, V. C., and Baker, B., 1986, Effect of vasodilator therapy on mortality in chronic congestive heart failure: Results of a Veteran’s Administration Cooperative Study, N. Engl. J. Med. 314:1547–1552.PubMedGoogle Scholar
  80. 80.
    Golucci, W. S., Wright, R. F., and Braunwald, E., 1986, New positive inotropic agents in the treatment of congestive heart failure: Mechanisms of action and recent clinical developments (2 part), N. Engl. J. Med. 314:290—299, 349–358.Google Scholar
  81. 81.
    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
  82. 82.
    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
  83. 83.
    Harken, D. E., 1977, Malnutrition: A poorly understood surgical risk factor in aged cardiac patients. Geriatrics 32:83–85.PubMedGoogle Scholar
  84. 84.
    Skinner, J. F., and Pearce, M. L., 1964, Surgical risk in the cardiac patient, J. Chronic Dis. 17:57–72.PubMedGoogle Scholar
  85. 85.
    Rao, T. L. K., Jacobs, K. H., and El-Etr, A. A., 1983, Reinfarction following anesthesia in patients with myocardial infarction, Anesthesiology 59:499–505.PubMedGoogle Scholar
  86. 86.
    Tarhan, S., Moffitt, E. A., Taylor, W. F., and Giuliani, E. R., 1972, Myocardial infarction after general anesthesia, JAMA 220:1451–1454.PubMedGoogle Scholar
  87. 87.
    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
  88. 88.
    American Heart Association Committee Report (E. L. Kaplan, Chairman), 1977, Prevention of bacterial endocarditis, Circulation 56(1):139A-143A.PubMedGoogle Scholar
  89. 89.
    Schneider, R. E., Fröhlich, E. D., and Messerli, F. H., 1986, Pathophysiology of hypertension in the elderly,Cardiol. Clin. 4:235–243.Google Scholar
  90. 90.
    Chobanian, A. V., 1984, Treatment of the elderly hypertensive patient. Am. J. Med. 77(2B):22–27.PubMedGoogle Scholar
  91. 91.
    Garvas, H., and Garvas, I., 1983,Hypertension in the Elderly, John Wright, PSG, Boston.Google Scholar
  92. 92.
    Horan, H. J., Steinberg, G. M., Dunbar, J. B., and Hadley, E. C. (eds.), 1986, NIH, Blood Pressure Regulation and Aging, Proceedings from a Symposium, Biomedical Information, New York.Google Scholar
  93. 93.
    Tsunooa, K., Abe, K., Goto, T., Yasujima, M., Sato, M., Omata, K., Seino, M., and Yoshinaga, K., 1986, Effect of age on the renin-angiotensin-aldosterone system in normal subjects: Simultaneous measurement of active and inactive renin, renin substitute, and aldosterone in plasma, J. Clin. Endocrinol. Metab. 62:384–389.Google Scholar
  94. 94.
    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
  95. 95.
    Pfeifer, M. A., Weinberg, C. R., Cook, D., Best, J., Reenan, A., and Halter, J. B., 1983, Differential changes of autonomic nervous system function with age in man.Am. J. Med. 75:249–258.PubMedGoogle Scholar
  96. 96.
    Vestal, R., Wood, A. J. J., and Shand, D. G., 1979, Reduced beta-adre- noreceptor sensitivity in the elderly, Clin. Pharmacol. Ther. 26:181–186.PubMedGoogle Scholar
  97. 97.
    Tobian, L., 1979, Dietary salt (sodium) and hypertension. Am. J. Clin. Nutr. 32(Suppl. 12):2659–2663.PubMedGoogle Scholar
  98. 98.
    Tobian, L., 1979, The relationship of salt to hypertension. Am. J. Clin. Nutr. 32(Suppl. 12):2739–2748.PubMedGoogle Scholar
  99. 99.
    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
  100. 100.
    Laragh, J. H., and Pecker, M. S., 1983, Dietary sodium and essential hypertension: Some myths, hopes and truths, Ann. Intern. Med. 98:(part 2):735–743.PubMedGoogle Scholar
  101. 101.
    Miall, W. E., and Lovell, H. G., 1967, Relation between change of blood pressure and age, Br. Med. J. 2:660–664.PubMedGoogle Scholar
  102. 102.
    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, London, pp. 143–175.Google Scholar
  103. 103.
    National Health Survey, 1975, Blood pressure of persons 18—74 years in United States from 1971–1972. National Center for Health Statistics, Rockville, MD.Google Scholar
  104. 104.
    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. Chronic Dis. 26:265–290.Google Scholar
  105. 105.
    Truswell, A. S., Kennelly, B. M., Hansen, J. D. L., and Lu, R. B., 1972, Blood pressure of Kury bushmen in northern Botswanna, Am. Heart J. 84:5–12.PubMedGoogle Scholar
  106. 106.
    Page, L. B., and Friedlaender, J., 1986, Blood pressure, age, and cultural change: A longitudinal study of Solomon Islands populations, in: NIH, Blood Pressure Regulation and Aging, Proceedings from a Symposium (M.J. Horan, G. M. Steinberg, J. B. Dunbar, and E. C. Hadley, eds.) Biomedical Information, New York, pp. 11–25.Google Scholar
  107. 107.
    Kaplan, N. M., 1983, Hypertension: Prevalence, risks, and effects of therapy. Ann. Intern. Med. 98(Part 2):705–709.PubMedGoogle Scholar
  108. 108.
    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
  109. 109.
    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, London, pp. 177–190.Google Scholar
  110. 110.
    Spence, J. D., Sibbald, W. J., and Cape, R. D., 1978, Pseudohypertension in the elderly. Clin. Sci. Mol. Med. 59:399s-402s.Google Scholar
  111. 111.
    Vardan, S., Mookherjee, S., Warner, E., and Smulyan, H., 1983, Systolic hypertension: Direct and indirect BP measurements. Arch. Intern. Med. 143:935–938.PubMedGoogle Scholar
  112. 112.
    O’Callaghan, W. G., Fitzgerald, D. J., O’Malley, K., and O’Brien, E., 1983, Accuracy of indirect blood pressure measurement in the elderly, Br. Med. J. 286:1545–1546.Google Scholar
  113. 113.
    Hla, K. M., Vokaty, K. A., and Feussner, J. B., 1985, Estimation of diastolic blood pressure in the elderly-magnitude of the problem and a potential solution. J. Am. Geriatr. Soc. 33:659–663.PubMedGoogle Scholar
  114. 114.
    Messerli, F. H., Ventura, H. O., and Amoder, C., 1985, Osier’s maneuver and pseudohypertension, N. Engl. J. Med. 312:1548–1551.PubMedGoogle Scholar
  115. 115.
    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
  116. 116.
    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
  117. 117.
    Hully, S. B., Furberg, C. D., Garland, B., McDonald, R., Perry, H. M., Schnaper, H. N., Schoenberger, J. A., McFate Smith, W., and Vogt, T. M., 1985, Systolic Hypertension in the Elderly Program (SHEP): Antihypertensive efficacy of chlorthalidone. Am. J. Cardiol. 56:913–920.Google Scholar
  118. 118.
    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
  119. 119.
    Olin, J. W., Vidt, D. G., Gifford, R. W., and Novich, A. C., 1985, Renovascular disease in the elderly: An analysis of 50 patients, JACC 5:1232–1238.PubMedGoogle Scholar
  120. 120.
    Grimm, E. E., Luft, F. C., Yune, H. Y., Klatte, E., and Weinberger, M., 1981, Percutaneous transluminal dilation in the treatment of renal vascular hypertension. Ann. Intern. Med. 95:439–442.Google Scholar
  121. 121.
    Sos, T. A., Pickering, T. G., Sniderman, K., Saddekni, S., Case, D. B., Silane, M. F., Vaughan, E. D., and Laragh, J. H., 1983, Percentaneous transluminal angioplasty in renovascular hypertension due to atheroma of fibromuscular dysplasia, N. Engl. J. Med. 309:274–279.PubMedGoogle Scholar
  122. 122.
    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, Chicago, pp. 69–73.Google Scholar
  123. 123.
    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
  124. 124.
    The Working Group on Hypertension in the Elderly 1986, Statement on hypertension in the elderly, JAMA 256:70–74.Google Scholar
  125. 125.
    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
  126. 126.
    Messerli, F. H., Ventura, H. O., Glade, L. B., Sundgaard-Riise, K., Dunn, F. G., and Fröhlich, E. D., 1983. Essential hypertension in the elderly: hemodynamics, intravascular volume, plasma renin activity, and circulating catecholamine levels. Lancet 2(8357):983–986.PubMedGoogle Scholar
  127. 127.
    Messerli, F. H., 1986, Osier’s maneuver, pseudohypertension, and true hypertension in the elderly. Am. J. Med. 80:906–910.PubMedGoogle Scholar
  128. 128.
    Vardan, S., Mookherjee, S., Warner, R., and Smulyan, H., 1983, Systolic hypertension in the elderly, JAMA 250:2807–2813.PubMedGoogle Scholar
  129. 129.
    Lake, C. R., Ziegler, M. G,. Coleman, M. D., and Kopin, I. J., 1977, Age- adjusted plasma norepinephrine levels are similar in normo tensive and hypertensive subjects, N. Engl. J. Med. 296:208–209.PubMedGoogle Scholar
  130. 130.
    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
  131. 131.
    Takeda, R., Morimoto, S., Uchida, K., Miyamori, L. and Hashiba, T., 1980, Effect of age on plasma aldosterone response to exogenous angiotensin II in normotensive subjects. Acta Endocrinol. 94:552–558.PubMedGoogle Scholar
  132. 132.
    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
  133. 133.
    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
  134. 134.
    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 sub- jects and in patients with essential hypertension, J. Clin. Endocrinol. Metab. 52:1023–1026.PubMedGoogle Scholar
  135. 135.
    Koch-Weser, J., 1979, Treatment of hypertension in the elderly, in: Drugs and the Elderly (J. Crooks and LH. Stevenson, eds.). University Park Press, Baltimore, pp. 247–262.Google Scholar
  136. 136.
    Gifford, R. W., 1986 Management of isolated systolic hypertension in the elderly, J. Am. Geriatr. Soc. 34:106–111.PubMedGoogle Scholar
  137. 137.
    Chobanian, A. V., 1981, Therapeutic decision making in systolic hypertension, Geriatrics 36(3):36–41.PubMedGoogle Scholar
  138. 138.
    The Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, 1984, The 1984 report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, Arch. Intern. Med. 144:1045–1057.Google Scholar
  139. 139.
    Gray, D. R., Weber, M. A., and Dryer, J., 1983, Effects of low dose antihypertensive therapy in elderly patients with predominant systolic hypertension, J. Gerontol. 38:302–306.PubMedGoogle Scholar
  140. 140.
    Five Year Findings of the Hypertension Detection and Follow-up Program, 1979, Reduction in mortality of persons with high blood pressure including mild hypertension, JAMA 242:2562–2571.Google Scholar
  141. 141.
    Five Year Findings of Hypertension Detection and Follow-up Program, 1979, II. Mortality by race, sex, and age JAMA 242:2572–2577.Google Scholar
  142. 142.
    Libow, L., and Buder, R. N., 1981, Treating mild diastolic hypertension in the elderly: Uncertain benefits and possible dangers, Geriatrics 36(11):55–62.PubMedGoogle Scholar
  143. 143.
    Kuramoto, K., Matsushita, S., Kuwajima, I., and Myrakami, M., 1981, Prospective study on the treatment of mild hypertension in the aged. Jpn. Heart J. 22:75–85.PubMedGoogle Scholar
  144. 144.
    Toth, P. J., and Horwitz, R. L, 1983, Conflicting clinical trials and the uncertainty of treating mild hypertension. Am. J. Med. 75:482–488.PubMedGoogle Scholar
  145. 145.
    Ram, C. V., 1984, Should mild hypertension be treated? Med. Clin. North Am. 68:469–476.PubMedGoogle Scholar
  146. 146.
    Grimm, R. H., 1984, Should mild hypertension be treated? Med. Clin. North Am. 68:477–490.PubMedGoogle Scholar
  147. 147.
    Multiple Risk Factor Intervention Trial Research Group, 1982, Multiple Risk Factor Intervention Trial, JAMA 248:1465–1477.Google Scholar
  148. 148.
    Amery, A., Birkenhager, W., Brixko, P., Bulpitt, C., Clement, D., Deruyt- tere, M., De Schaepdryvers, A., Dollery, C., Fagard, R., Forrette, F., Forte, J., Hamdy, R., Henry, J. F., Joosens, J. V., Leonetti, G., Lund-Johansen, P., O’Mally, K., Petrie, J. C., Strasser, T., Tuomilehto, J., and Williams, B., 1985. Mortality and morbidity results from the European Working Party on high blood pressure in the elderly trial. Lancet 1:1349–1354.PubMedGoogle Scholar
  149. 149.
    Amery, A., Birkenhager, W., Brixko, P., Bulpitt, C., Clement, D., Deruyt- tere, M., De Schaepdryvers, A., Dollery, C., Fagard, R., Forrette, F., Forte, J., Hamdy, R., Henry, J. F., Joosens, J. V., Leonetti, G., Lund-Johansen, P., O’Mally, K., Petrie, J. C., Strasser, T., Tuomilehto, J., and Williams, B., Efficacy of antihypertensive drug treatment ascending to age, sex, blood pressure, and previous cardiovascular disease in patients over the age of 60, Lancet 2:589–592.Google Scholar
  150. 150.
    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
  151. 151.
    MacGregor, G. A., Markanov, W. D., Best, F. E., Elder, D. M., Cam, J. M., Sagnella, G. A., and Squires, M., 1982, Double-blinded randomized cross over trial of moderate sodium restriction in essential hypertension. Lancet l (8268):351–355.PubMedGoogle Scholar
  152. 152.
    Morgan, T. C., Nowson, C., Murphy, J., and Snowden, R., 1986. Compliance and the elderly hypertensive. Drugs 31(Suppl. 4): 174–183.PubMedGoogle Scholar
  153. 153.
    Langford, H. G., 1983, Potassium in hypertension, Postgrad. Med. 73:227–233.PubMedGoogle Scholar
  154. 154.
    McCarron, D. A., Morris, C. D., Henry, H. J., and Stanton, J. L., 1984, Blood pressure and nutrient intake in the United States, Science 224:1392–1398.PubMedGoogle Scholar
  155. 155.
    Reisin, E., Abel, R., Modan, M., Silverberg, D., Eliahou, H., and Modan, B.,1978, Effect of weight loss without salt restriction on reduction of blood pressure in overweight hypertensive patients, N. Engl. J. Med. 298:1–6.PubMedGoogle Scholar
  156. 156.
    Nelson, L., Jennings, G. L., Esler, M. D., and Korner, P. I., 1986, Effect of changing levels of physical activity on blood pressure and hemodynamics in essential hypertension. Lancet 2:473–476.PubMedGoogle Scholar
  157. 157.
    Prosnitz, E. H., 1982, Therapy of hypertension, in: Drug Therapy for the Elderly (K. Conrad and R. Bressler, eds.), C. V. Mosby, St. Louis.Google Scholar
  158. 158.
    Morisky, D. E., Levine, D. M., Green, L. W., and Smith, C. R., 1982, Health education program effects on the management of hypertension in the elderly.Arch. Intern. Med. 142:1835–1838.PubMedGoogle Scholar
  159. 159.
    Navarro, R., O’Brien, D. L., Nuffort, P., and Spencer, D. L., 1982, Diuretic induced hypoklemia in the elderly, J. Family Pract. 14:685–689.Google Scholar
  160. 160.
    Resnick, N., and Subbarao, V. Y., 1985, Current concepts: Management of urinary incontinence in the elderly, N. Engl. J. Med. 313:800–805.PubMedGoogle Scholar
  161. 161.
    Thanopavarn, C., Golub, M. S., and Sambhi, M. P., 1983, Clonidine in the elderly hypertensive, Chest 83(Suppl.):410s-411s.Google Scholar
  162. 162.
    Messerli, F. H., Dreslinski, G. R., Husserl, R. E., Svarez, D., MacPhee, A., and Fröhlich, E., 1981, Antiadrenergic therapy: Special aspects in hypertension in the elderly. Hypertension 3(Suppl. 11):226–229.Google Scholar
  163. 163.
    Sotaniemi, E. A., Hukkanen, O. T., Akokas, J. L, 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
  164. 164.
    Castelden, C. 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
  165. 165.
    Wirstrand, J., Westergren, G., Berglund, G., Braccheti, D., Van Couter, A., Feldstein, C. A., Ming, K. S., Kuramoto, K., Landahl, S., Meaney, E., Pedersen, E. B., Rahn, K. H., Shaw, J., Smith, A., and Waal-Manning, H., 1986, Antihypertensive treatment with metoprolol or hydrochlorthiazide in patients aged 60 to 75 years, JAMA 255:1304–1310.Google Scholar
  166. 166.
    Veterans 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
  167. 167.
    Luxemberg, J., and Feigenbaum, L. F., 1983, The use of reserpine for elderly hypertensive patients, J. Am. Geriatr. Soc. 31:556–559.Google Scholar
  168. 168.
    Appelgate, W. B., Carper, E. R., Kahn, S. E., Westbrook, L., Linton, M., Baker, M. G., and Runyan, J. W., 1985, Comparison of the use of reserpine versus alpha-methyldopa for second step treatment of hypertension in the elderly, J. Am. Geriatr. Soc. 33:109–115.Google Scholar
  169. 169.
    Vidt, D. G., Bravo, E. L., and Fouad, F. M., 1982, Drug therapy—Captopril, N. Engl. J. Med. 306:214–219.PubMedGoogle Scholar
  170. 170.
    Jenkins, A. C., Knill, J. R., and Dreslinsi, G. R., 1985. Captopril in the treatment of the elderly hypertensive patient. Arch. Intern. Med. 145:2029–2031.PubMedGoogle Scholar
  171. 171.
    Tuch, M. L., Katz, L. A., Kirkendall, W. M., Koeppe, P. R., Ruoff, G. E., and Sapir, D. G., 1986, Low dose Captopril in mild to moderate geriatric hypertension, J. Am. Geriatr. Soc. 34:693–696.Google Scholar
  172. 172.
    Woo, J., Woo, K. S., and Vallance-Owen, J., 1986, Captopril versus hydro- chlorthiazide—triamterene in mild-to-moderate hypertension in the elderly, Lancet 2:924.PubMedGoogle Scholar
  173. 173.
    Cressman, M. D., Gifford, R. W., and Vidt, D. G., 1985, Geriatric hypertension controversies: Uses of new agents, Geriatrics 40(11):53—68.PubMedGoogle Scholar
  174. 174.
    Anonymous, 1983, Bumetanide—A new “loop” diuretic, Med. Lett. 25:61–63.Google Scholar
  175. 175.
    Anonymous, 1984, Indapamide—A new antihypertensive agent and diuretic, Med. Lett. 26:17–18.Google Scholar
  176. 176.
    Anonymous, 1983, Guanadril—A new andhypertensive drug, Med. Lett. 25:95–96.Google Scholar
  177. 177.
    Anonymous, 1983, Guanabenz—A new antihypertensive drug, Med. Lett. 25:11–12.Google Scholar
  178. 178.
    Stessman, J., Leibel, B., Yagil, Y., Eliakim, R., and Ben-Ishay, D., 1985, Nifidipine in the treatment of hypertension in the elderly, J. Clin. Pharmacol. 25:193–196.PubMedGoogle Scholar
  179. 179.
    Anonymous, 1985, Acebutolol, Med. Lett. 27:58–60.Google Scholar
  180. 180.
    Anonymous, 1986, Choice of a beta blocker, Med. Lett. 28:20–22.Google Scholar

Copyright information

© Plenum Publishing Corporation 1988

Authors and Affiliations

  • Edmund H. DuthieJr.
    • 1
  • Michael H. KeelanJr.
    • 2
    • 3
  1. 1.Section of Geriatrics and Gerontology, Department of MedicineMedical College of WisconsinMilwaukeeUSA
  2. 2.Section of Cardiology, Department of MedicineMedical College of WisconsinMilwaukeeUSA
  3. 3.Milwaukee County Medical ComplexMilwaukeeUSA

Personalised recommendations