Practical recommendations for treatment of hypertension in older patients

Philip A Kithas, Mark A SupianoGeriatric Research, Education, and Clinical Center, George E Wahlen Department of Veterans Affairs Medical Center and Department of Internal Medicine, Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Utah, USABackground: By the year 2030 the percent of the population over the age of 65 years is projected to range from 3.7% (in sub-Saharan Africa) to almost 22% (in Europe). Accompanying this unprecedented growth will be a significant increase in many of the disease processes or “comorbidities” associated with aging, not the least of which is hypertension. Global health care resources and economies in general will be stressed to breaking point if this condition is not dealt with in an aggressive and timely manner because the consequences of untreated hypertension such as stroke, myocardial infarction, and dementia are exceedingly costly in the long term.Methods: To help focus attention on the worldwide epidemic of hypertension, the current literature and guidelines were reviewed, along with information on the various classes of medications indicated in the treatment of hypertension in the elderly. Results: Recent, large, randomized trials indicate that hypertension in the elderly can and should be treated to lower the incidence of stroke, myocardial infarction, and chronic kidney disease. Although thiazide-type diuretics are the recommended first-line agents in most cases of uncomplicated hypertension, multiple drug classes have been shown to be useful. In addition, and where feasible, a multidisciplinary team approach has demonstrated the most durable results.Conclusion: Thiazide diuretics should be the first-line agents in uncomplicated, isolated systolic hypertension. Starting at low doses and proceeding in a gradual manner, these agents have proven efficacy in decreasing the risk of stroke and cardiovascular events. It is now recommended that these agents be used in low-dose combinations with other antihypertensive drug classes in patients who do not achieve target blood pressure (<140/90 mmHg).Keywords: isolated systolic hypertension, pulse pressure, ambulatory blood pressure monitorin

Age wave is here : the aging of the baby boomers November 2010

ManuscriptPaul C. Light (1998) wrote one of the first books to examine the complexities of the baby boom generation and their future implications and impact. The book titled, "Baby Boomers", investigated what unified and what divided the generation and reflected on the potential for "golden days" (would it be the 1990s?). Since one now has the luxury of looking back over the 90s and the first decade of the new century to see if those years were indeed the "golden years" for boomers, one will have to give credit to Light (1988) for raising the consciousness of how the cohort would have to eventually confront the challenges of an aging society due to the demographic transition of boomers entering the "retirement years." What is also interesting is that Light (1988) elevated the year 2016 - when the boomers reach the age of 70 - as having the most significance in terms of social, political, economic and cultural impact

Sensitization of human α 1 ‐ and α 2 ‐adrenergic venous responses by guanadrel sulfate

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109986/1/cptclpt1990190.pd

Serial Changes in Norepinephrine Kinetics Associated With Feeding Dogs a High-Fat Diet

J Clin Hypertens (Greenwich). 2010;12:117–124. © 2009 Wiley Periodicals, Inc. The role of increased sympathetic nervous system (SNS) activity in the pathogenesis of obesity hypertension and insulin resistance is controversial. Eight dogs were instrumented and fed a high-fat diet (HFD) for 6 weeks. Dogs were evaluated for changes in weight, blood pressure, insulin resistance, and norepinephrine (NE) kinetics using a two-compartment model. The HFD resulted in weight gain, hypertension, and insulin resistance. During the 6 weeks of the HFD, although plasma NE concentration trended toward increasing ( P =.09), SNS, assessed by NE kinetic studies, significantly increased ( P =.009). Within 1 week of starting the HFD, NE release into the extravascular compartment (NE 2 ) increased from 3.44±0.59 μg/mL to 4.87±0.80 μg/mL ( P <.01) and this increase was maintained over the next 5 weeks of the HFD (NE 2 at week 6 was 4.66±0.97 μg/mL). In addition to the increased NE 2 there was also a significant increase in NE clearance ( P =.04). There were significant correlations between the increase in NE 2 and both the development of insulin resistance and hypertension. This study supports the hypothesis that activation of the SNS plays a pivotal role in the metabolic and hemodynamic changes that occur with weight gain induced by HFD.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78633/1/j.1751-7176.2009.00230.x.pd

Atrophic Gastritis and Vitamin B12 Deficiency

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111159/1/j.1532-5415.1987.tb04684.x.pd

The effects of ramipril on sympathetic nervous system function in older patients with hypertension

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109895/1/cptclpt1999387.pd

Resistance training enhances insulin-mediated glucose disposal with minimal effect on the tumor necrosis factor-alpha system in older hypertensives

The purpose of the present study was to determine if the improvement in insulin sensitivity after resistance training (RT) is associated with a decline in plasma levels of tumor necrosis factor-alpha (TNF-α), soluble TNF-α receptor 1 (sTNF R1), and soluble TNF receptor 2 (sTNF R2). Eleven older hypertensives (5 men/6 women, 67 ± 2 years) participated in a 4-month RT program. Following RT there was a significant increase in upper body (P = .029) and lower body strength (P = .001), assessed by the bench press 1-repetition maximum (1RM) and leg press 1RM, respectively. The RT program produced a significant increase in lean body mass (LBM) (P = .029), a trend for a decline in percent body fat (P = .083), and no change in total body mass (P = .958). Insulin-mediated glucose disposal, assessed by the hyperinsulinemic euglycemic clamp procedure, significantly increased following RT (P = .026). Despite the increase in insulin action, plasma levels of TNF-α, sTNF R1, and sTNF R2 were not significantly altered by RT (TNF-α: P = .118, sTNF R1: P = .184, STNF R2: P = .168). In conclusion, a 4-month RT program significantly increased insulin-mediated glucose disposal and LBM without a significant reduction in plasma levels of TNF-α, sTNF R1, and sTNF R2 in older hypertensive subjects. © 2004 Elsevier Inc. All rights reserved