The risks of hypertension in the elderly
Norman M Kaplan in Hypertension in the Elderly: Pocketbook, 1999
None the less, the presence of hypertension poses an additional risk for cardiovascular damage at all ages. Perhaps the clearest portrayal of the progressive increase in both heart attack and stroke with increasing blood pressure is the analysis of MacMahon et al. (1990) (Figure 10). Their curves are constructed using data from multiple prospective observational studies in which over 450 000 subjects were followed without therapy for variable periods. These relative risk relationships are for diastolic blood pressure but, as we shall see, the degrees of risk are even steeper for systolic blood pressure.
Older versus younger
Norman M Kaplan in Hypertension in the Elderly: Pocketbook, 1999
A possible exception to the progressive risks associated with every rise in systolic pressure has been claimed for the very old, i.e. people over the age of 85. Satish et al. (2001) noted better survival in people aged 85 and older with higher initial systolic and diastolic blood pressure than in those with lower readings. This inverse relation may be mainly due to the poor general health that leads to low blood pressure in the elderly.
THE CRITERIA FOR TREATMENT
Roger Blackwood in Cardiology for Lawyers, 1996
The current situation is that borderline blood pressure is watched carefully and treatment is only instituted once the diastolic blood pressure reaches 100 or more on a regular basis, although this might be slightly different in the elderly patient. A middle-aged patient with a blood pressure of 160/100 will live approximately 14 years less than an equivalent patient with a blood pressure of 120/80. The greater the pressure left untreated, the greater the risk. Moderately high blood pressure (diastolic 105-120) carries a 20% mortality at the end of five years if left untreated, and severe hypertension carries a 60% mortality over the same period of time if left untreated. If the blood pressure is borderline, but there is evidence of damage to the brain, heart or kidneys, reducing the blood pressure is beneficial. Evidence of loss of function in the brain, heart or kidneys is known as end organ damage, and it is for evidence of this that the patient is investigated.
Definitions and Characteristics of Salt-sensitivity and Resistance of Blood Pressure: Should the Diagnosis Depend on Diastolic Blood Pressure?
Published in Clinical and Experimental Hypertension. Part A: Theory and Practice, 1992
B. Wedler, M. Wiersbitzki, S. Gruska, E. Wolf, F. C. Luft
To elucidate the importance of diastolic blood pressure in the definition of salt-sensitive hypertension, we studied 54 male subjects, 36 of whom had untreated, mild essential hypertension. The subjects received a 120 mmol/d Na (as the chloride salt) diet for six days. Thereafter they received a 10 mmol/d Na diet for eight days followed by a 400 mmol/d Na diet for another 8 days. Blood pressure was measured hourly “around the clock” on the last day of each diet; the averaged systolic, diastolic and mean blood pressure values were compared. In 22 subjects diastolic blood pressure increased when salt intake was increased from 10 to 400 mmol/d. In 18 of these 22 subjects systolic blood pressure increased as well. In 20 subjects, systolic blood pressure increased with salt loading while diastolic blood pressure decreased in 13 subjects both systolic and diastolic blood pressure decreased with increased salt intake. We defined those subjects showing an increase in diastolic blood pressure as salt-sensitive. If mean blood pressure were used to define salt-sensitivity, 8 of our subjects whould have been labled as salt-sensitive who actually decreased their diastolic blood pressure with salt-loading. We suggest that consideration of systolic and diastolic blood pressure responses gives better insight into identifying volume and resistance-related phenomena in salt-sensitive hypertension, than does the consideration of mean blood pressure alone. The definition of salt-sensitivity may require reassessment.
Evaluation of the Reproducibility and Accuracy of Ambulatory Blood Pressure Monitoring Using the Takeda TM-2420 Automated Blood Pressure Monitor
Published in Clinical and Experimental Hypertension, 1993
J. J. Kelly, S. N. Hunyor, K. Y. Ho
The reproducibility of ambulatory blood pressure measurements was assessed in eight normotensive subjects who underwent three separate days of recording, using Takeda Medical TM-2420 (TM-2420) blood pressure monitors. The coefficients of variation of mean 24 hour systolic and diastolic blood pressure were 2.1% and 2.8% respectively. The corresponding values for systolic and diastolic blood pressure variability, were 19% and 14% respectively. Measurement intervals of greater than 30 minutes significantly reduced the reproducibility of mean day interval systolic measurements. The bias of the TM-2420 systolic and diastolic blood pressure measurements compared to standard sphygmomanometer measurement were 0 ± 7 mmHg and 1 ± 6 mmHg respectively. Ambulatory blood pressure monitoring provides reproducible estimates of mean systolic and diastolic blood pressure, however, blood pressure variability is poorly reproducible.
The LH-specificity in Patients with High Diastolic Blood Pressure
Published in Journal of Human Ecology, 1993
Shyamal Koley, Y.R. Saxena, P.K. Shrivastava
The LB-specificity refers to weak (LH-negative) or strong (LH-Positive) agglutination of erythrocytes obtained with the lectin from Erythrina lithosperrna. The LH status of patients with high diastolic blood pressure has been estimated by this anti-LH lectin. Blood samples from 105 confirmed cases of high diastolic blood pressure were typed both for the ABO blood groups and LH-specificity and compared with an appropriate control. The malts suggest no association between patients with high diastolic blood pressure and the LH reaction patterns.