Advertisement

Systolic hypertension in the elderly

  • Edward D. Frohlich
  • Franz H. Messerli
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 63)

Abstract

The overall problem of hypertension in the aging patient has received increasing attention in recent years. Appreciation of this major concern has increased for several reasons: (1) the elderly segment of most Western industrialized populations (i.e., individuals older than 65 years of age) has more than doubled during this generation to upwards of 10 to 15 percent of the total population [1, 2] and this proportion is still increasing; (2) upwards of 50 percent of this elderly population have either diastolic or isolated systolic hypertension [3, 4]; (3) relatively recent reports demonstrate that the rise of arterial pressure with aging is neither a ‘normal’ nor an innocuous physiological phenomenon [5–10]; (4) reduction of arterial pressure in elderly individuals may be expected to be associated with an overall reduction in cardiovascular morbidity and mortality [11–14]; and (5) the recent emphasis on the feasibility of reducing isolated systolic arterial pressure elevation by pharmacological means [15] has led to a large multicenter study designed to demonstrate the safety and efficacy of its pharmacological treatment.

Keywords

Diastolic Pressure Systolic Hypertension Total Peripheral Resistance Arterial Compliance Isolate 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.
    Health and Nutritional Examination Study (HANES), 1971–1974 Vital and Health Statistics Series II, No. 203 (1977): Blood pressure levels of persons 60–74. U.S. National Center for Health Statistics, Department of Health, Education, and Welfare.Google Scholar
  2. 2.
    Office of Population Consensus and Surveys (1971): Population projections, 1970–2010. London, H.M.S.O.Google Scholar
  3. 3.
    Ostfeld AM, Shekelle RB, Klawans H, Tufo HM (1974): Epidemiology of stroke in an elderly welfare population. Am J Pub Healh 64: 450–458.CrossRefGoogle Scholar
  4. 4.
    Drizd T, Dannenberg A, Engel A: Blood presssure levels in persons 18–74 years of age in 1976–80, and trends in blood pressure from 1960–80 in the United States. Vital Health Stat 1986; 11, DHHS Publication No. (PHS) 86–1684.Google Scholar
  5. 5.
    Page LB (1980): Hypertension and atherosclerosis in primitive and acculturating societies. In: Hypertension Update: Mechanisms, Epidemiology, Evaluation, and Management, Hunt JC (ed), Bloomfield, NJ, Health Learning Systems, pp 1–12.Google Scholar
  6. 6.
    Genest J, Larochelle P, Kuchel O, Hamet P, Cantin M (1983): Hypertension in the elderly: athero-arteriosclerotic hypertension, Chapter 56. In: Hypertension: Physiopathology and Treatment, 2nd ed, Genest J, Kuchel O, Hamet P, Cantin M (eds). New York, McGraw-Hill Book Company, pp 913–921.Google Scholar
  7. 7.
    Atherosclerosis Study Group: Kannel WB, Doyle JT, Ostfeld AM, Jenkins CD, Kuller L, Podell RN, Stamler J (1984): Optimal resources fom primary prevention of atherosclerotic diseases. Circulation 70: 157A-205A.CrossRefGoogle Scholar
  8. 8.
    Kannel WB (1976): Some lessons in cardiovasular epidemiology from Framingham. Am J Cardiol 37: 269–282.PubMedCrossRefGoogle Scholar
  9. 9.
    Kannel WB (1981): Implications of Framingham study data for treatment of hypertension: Impact of other risk factors. In: Frontiers in Hypertension Research, Laragh JH, Bühler FR, Seldin DW (eds), New York, Springer-Verlag, pp 17–21.CrossRefGoogle Scholar
  10. 10.
    Shekelle RB, Ostfeld AM, Klawans HL Jr (1974): Hypertension and risk of stroke in an elderly population. Stroke 5: 71–75.PubMedCrossRefGoogle Scholar
  11. 11.
    Hypertension Detection and Follow-Up Program Cooperative Group (1979): Five-year findings of the Hypertension Detection and Follow-Up Program. II. Mortality by race, sex and age. JAMA 242: 2572–2577.CrossRefGoogle Scholar
  12. 12.
    Hypertension Detection and Follow-Up Program Cooperative Group (1982): Five-year findings of the Hypertension Detection and Follow-Up Program. III. Reduction in stroke incidence among persons with high blood pressure. JAMA 247: 633–638.CrossRefGoogle Scholar
  13. 13.
    National Heart Foundation of Australia (1981): Treatment of mild hypertension in the elderly: Report by the Management Committee. Med J Aust 2: 398–402.Google Scholar
  14. 14.
    Amery A, Birkenhäger W, Brixko P, Bulpitt C, Clement D. Deruyttere M, De Schaepdryver A, Dollery C, Fagard R, Forette F, Forte J, Hamdy R, Henry JF, Joossens JV, Leonetti G, Lund-Johansen P, O’Malley K, Petrie J, Strasser T, Tuomilehto J, Williams B (1985): Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly Trial. Lancet 1(8442): 1349–1354.PubMedCrossRefGoogle Scholar
  15. 15.
    Hughes G, Schnaper HW (1982): The isolated systolic hypertension in the elderly program. International Journal of Mental Health 2: 76–97.Google Scholar
  16. 16.
    Blood Pressure Study 1979. Chicago: Society of Actuaries and Association of Life Insurance Medical Directors of America, 1980.Google Scholar
  17. 17.
    The Joint National Committee on the 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.CrossRefGoogle Scholar
  18. 18.
    Report of WHO Expert Committee (1978): Arterial Hypertension, World Health Organization Technical Report Series, No. 628. Geneva, Switzerland, World Health Organization.Google Scholar
  19. 19.
    Final Report of the Subcommittee on Definition and Prevalence of the 1984 Joint National Committee (1985): Hypertension prevalance and the status of awareness, treatment, and control in the United States. Hypertension 7: 457–468.Google Scholar
  20. 20.
    Wing S, Aubert RE, Hansen JP, Hames CG, Slome C, Tyroler HA (1982): Isolated systolic hypertension in Evans County. I. Prevalence and screening considerations. J Chronic Dis 35: 735–742.PubMedCrossRefGoogle Scholar
  21. 21.
    Curb JD, Borhani NO, Entwisle G, Tung B, Kass E, Schnaper H, Williams W, Berman R (1985): Isolated systolic hypertension in 14 communities. Am J Epidemiol 121: 362–370.PubMedCrossRefGoogle Scholar
  22. 22.
    National Center for Health Statistics, Blood Pressure Levels of Persons 6–74 years. United States, 1971–1974, Series 11, No. 203. Rockville, MD: National Center for Health Statistics, 1977. (DHEW publication no. [HRA] 78–1648).Google Scholar
  23. 23.
    Hulley SB, Furberg CD, Gurland B, McDonald R, Perry HM, Schnaper HW, Schoenberger JA, Smith WMcF, Vogt TM (1985): Systolic hypertension in the elderly program (SHEP): Antihypertensive efficacy of chlorthalidone. Am J Cardiol 56: 913–920.PubMedCrossRefGoogle Scholar
  24. 24.
    Adamopoulos PN, Chrysanthakopoulis SG. Frohlich ED (1975): Systolic hypertension: Nonhomogeneous diseases. Am J Cardiol 36: 697–701.PubMedCrossRefGoogle Scholar
  25. 25.
    Messerli FH, Sundgaard-Riise K, Ventura HO, Dunn FG, Glade LB, Frohlich ED (1983): Essential hypertension in the elderly: Haemodynamics, intravascular volume, plasma renin activity, and circulating catecholamines. Lancet 2: 983–986.PubMedCrossRefGoogle Scholar
  26. 26.
    Messerli FH, Ventura H, Aristimuño GG, Suarez DH, Dreslinski GR, Frohlich ED (1982): Arterial compliance in systolic hypertension. Clin Exper Hyper A4: 1037–1044.CrossRefGoogle Scholar
  27. 27.
    Simon AC, Safar MA, Levenson JA, Kheder AM, Levy BI (1979): Systolic hypertension: Hemodynamic mechanisms and choice of antihypertensive treatment. Am J Cardiol 44: 505–511.PubMedCrossRefGoogle Scholar
  28. 28.
    Hallock P, Benson IC (1937): Studies on the elastic properties of human isolated aorta. J Clin Invest 16: 595–602.PubMedCrossRefGoogle Scholar
  29. 29.
    Peterson LH, Jensen RE, Parnell J (1960): Mechanical properties of arteries in vivo. Circ Res 8: 622–639.Google Scholar
  30. 30.
    Gow BS, Taylor MG (1968): Measurement of viscoelastic properties of arteries in the living dog. Circ Res 23: 111–122.PubMedGoogle Scholar
  31. 31.
    O’Rourke MF (1970): Arterial hemodynamics in hypertension. Circ Res 27 (II): 123–133.PubMedGoogle Scholar
  32. 32.
    Finberg MH (1927): Systolic hypertension: its relationship to atherosclerosis of the aorta and larger arteries. Am J Med Sci 173: 835–842.CrossRefGoogle Scholar
  33. 33.
    Wolinski H (1972): Response of the rat aortic media to hypertension. Circ Res 30: 301–309.Google Scholar
  34. 34.
    Tarazi RC, Magrini F, Dustan HP (1975): The role of aortic distensibility in hypertension. In: International Symposium On Recent Advances in Hypertension, Miller P, Safar ME (eds), Monte Carlo, Boehringer Ingelheim, pp 133–142.Google Scholar
  35. 35.
    Randall OS, Esler MD, Calfee RV. Bullock GF, Maisel AS, Culp B (1976): Arterial compliance in hypertension. Aust NZ J Med 6 (II): 49–59.CrossRefGoogle Scholar
  36. 36.
    Alicandri CL, Agabiti-Rosei E, Fariello R, Beschi M, Boni E, Castellano M, Montini E, Romanelli G, Zaninelli A, Muiesan G (1982): Aortic rigidity and plasma catecholamines in essential hypertensive patients. Clin Exper Hyper A4: 1073–1083.CrossRefGoogle Scholar
  37. 37.
    Hallback M, Lundgren Y, Weiss L (1974): The distensibility of the resistance vessels in spontaneously hypertensive rats (SHR) as compared with normotensive control rats (NCR). Acta Physiol Scand 90: 57–68.PubMedCrossRefGoogle Scholar
  38. 38.
    Mulvany MJ, Halpern W (1977): Contractile properties of small arterial resistance vessels in spontaneously hypertensive and normotensive rats. Circ Res 41: 19–26.PubMedGoogle Scholar
  39. 39.
    Landowne M (1958): The relation between intraarterial pressure and impact pulse wave velocity with regard to age and atherosclerosis. J Gerontol 13: 153–162.PubMedGoogle Scholar
  40. 40.
    Abboud FM, Huston JH (1961): The effects of aging and degenerative vascular disease on the measurement of arterial rigidity in man. J Clin Invest 40: 933–939.PubMedCrossRefGoogle Scholar
  41. 41.
    Abboud FM, Huston JH (1961): Measurement of arterial aging in hypertensive patients. J Clin Invest 40: 1915–1921.PubMedCrossRefGoogle Scholar
  42. 42.
    Folkow B (1978): Cardiovascular structural adaptation; its role in the initiation and maintenance of primary hypertension. Clin Sci Mol Med 55: 3s-22s.Google Scholar
  43. 43.
    Gribbin B, Pickering TJ, Sleight P (1979): Arterial wall distensibility in normal and hypertensive men. Clin Sci 56: 413–417.PubMedGoogle Scholar
  44. 44.
    Messerli FH, Ventura HO, Amodeo C (1985): Osier’s maneuver and pseudohypertension. N Eng J Med 312: 1548–1551.CrossRefGoogle Scholar
  45. 45.
    Simon AC, Safar ME, Levenson JA, London GM, Levy BI, Chau NP (1979): An evaluation of large arteries compliance in man. Am J Physiol 237: H550–H554.PubMedGoogle Scholar
  46. 46.
    Safar ME, Simon AC, Levinson JA (1984): Structural changes of large arteries in sustained essential hypertension. Hypertension 6 (Suppl. 3): 117–121.Google Scholar
  47. 47.
    Ventura HO, Messerli FH, Oigman W, Suarez DH, Dreslinski GR, Dunn FG, Reisin E, Frohlich ED (1984): Impaired systemic arterial compliance in borderline hypertension. Am Heart J 108: 132–136.PubMedCrossRefGoogle Scholar
  48. 48.
    Smulyan H, Vardau S, Griffiths A, Gribbin B (1984): Forearm arterial distensibility in systolic hypertension. J Am Coll Cardiol 2: 387–393.CrossRefGoogle Scholar
  49. 49.
    European Working Party on High Blood Pressure in the Elderly. Antihypertensive therapy in patients above age 60 with systolic hypertension. Clin Exper Hypertension 4: 1151–1176.Google Scholar
  50. 50.
    Seligmon AW, Alderman MH, Davis TK (1979): Systolic hypertension: occurrence and treatment in a defined community. J Am Geriat Soc 27: 135–138.Google Scholar
  51. 51.
    Niarchos AP, Weinstein DL, Laragh JH (1984): Comparison of the effects of diuretic therapy and low sodium intake in isolated systolic hypertension. Am J Med 77: 1061–1068.PubMedCrossRefGoogle Scholar
  52. 52.
    Niarchos AP, Laragh JH (1984): Renin dependency of blood pressure in isolated systolic hypertension. Am J Med 77: 407–414.PubMedCrossRefGoogle Scholar
  53. 53.
    Page IH (1967): The mosaic theory of arterial hypertension - its interpretation. Perspect Biol Med 10: 325–333.PubMedGoogle Scholar
  54. 54.
    Frohlich ED (1983): Mechanisms contributing to high blood pressure. Ann Intern Med 98: 709–714.PubMedGoogle Scholar
  55. 55.
    Koch-Weser J (1973): Correlation of pathophysiology and pharmacotherapy in primary hypertension. Am J Cardiol 32: 499–510.CrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishers, Dordrecht. 1987

Authors and Affiliations

  • Edward D. Frohlich
  • Franz H. Messerli

There are no affiliations available

Personalised recommendations