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High Blood Pressure - Management Of Hypertension

clinical systolic lancet trial elderly

Despite the evidence that treatment is beneficial in terms of reducing morbidity and mortality, hypertension is still poorly controlled in elderly persons. Both in the United States and in Europe, less than 30 percent of patients on hypertensive drugs attain the JNC-VI goal blood pressure (<140 and <90 mmHg) (JNC-VI; Burt et al.). Achieving the goal is relatively easy for diastolic blood pressure, but much harder for systolic blood pressure. Moreover, the new indication of pulse pressure as the most powerful risk factor must now lead doctors to consider systolic rather than diastolic blood pressure when determining treatment goals. Consequently, the development of drugs that lower systolic blood pressure more effectively should be promoted (Staessen et al., 2000). Blacher et al. have emphasized the need for randomized trials with anti-hypertensive drugs that act differently on the pulsatile component of blood pressure. These authors suggested that vasopeptidase inhibitors and nitric oxide donors might increase the distensilibility of large arteries and reduce pulse pressure.



AMERY, A.; BIRKENHÄGER, W.; BRIXKO, P.; BULPITT, C.; CLEMENT, D.; DERUYTTERE, M.; DE SHAEPDRYVER, A.; DOLLERY, C.; FAGARD, R.; FORETTE, F.; FORTE, J.; HAMDY, R.; HENRY, J. F.; JOOSSENS, J. V.; LEONETTI, G.; LUND-JOHANSSEN, P.; O'MALLEY, K.; PETRIE, J.; TRASSER, T.; TUOMILEHTO, J.; and WILLIAMS, B. "Mortality and Morbidity Results from the European Working Party on High Blood Pressure in the Elderly Trial." Lancet 1, no. 8442 (1985): 1349–1354.

BLACHER, J.; STAESSEN, J. A.; GIRERD, X.; GAZOWSKY, J.; THIJS, L.; LIU, L.; WANG, J. G.; FAGARD, ROBERT; and SAFAR, MICHEL. "Pulse Pressure Not Mean Pressure Determines Cardiovascular Risk in Older Hypertensive Patients." Archives of Internal Medicine 160 (2000): 1085–1089.

BURT, V. L.; WHELTON, P.; ROCCELLA, E. J.; BROWN, C.; CUTLER, J. A.; HIGGINS, M.; HORAN, M. J.; and LABARTHE, D. "Prevalence of Hypertension in the U.S. Adult Population: Results from the Third National Health and Nutrition Examination Survey, 1988–1991." Hypertension 25 (1995): 305–313.

DAHLÖF, B.; LINDHOLM, L. H.; HANSSON, L.; SCHERSTÉN, B.; EKBOM, T.; and WESTER, P. O. "Morbidity and Mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension)." Lancet 338 (1991): 1281–1285.

FORETTE, F.; DE LA FUENTE, X.; GOLMARD, J. L.; HENRY, J-F.; and HERVY, M-P. "The Prognostic Significance of Isolated Systolic Hypertension in the Elderly. Results of a Ten-Year Longitudinal Survey." Clinical Experimental Hypertension A4 (1992): 1177–1191.

FORETTE, F.; SEUX, M-L.; STAESSEN, J. A.; THIJS, L.; BIRKENHÄGER, W. H.; BARBASKIENE, M-R.; BABEANU, S.; BOSSINI, A.; GOL-EXTREMERA, B.; GIRERD, X.; LAKS, T.; LILOV, E.; MOISSEYEV, V.; TUOMILEHTO, J.; VANHANNEN, H.; WEBSTER, J.; YODFAT, Y.; and FAGARD, R. "On Behalf of the Syst-Eur Investigators. Prevention of Dementia in Randomized Double-Blind Placebo-Controlled Systolic Hypertension in Europe (Syst-Eur) Trial." Lancet 352 (1998): 1347–1351.

GUEYFFIER, F.; BULPITT, C.; BOISSEL, JEAN-PIERRE; SCHRON, ELEANOR; EKBOM, TORK; FAGARD, ROBERT; CASIGLIA, EDOARDO; KERLIKOWSKE, K.; and COOPE, J. "Antihypertensive Drugs in Very Old People: A Subgroup Meta-Analysis of Randomised Controlled Trials." Lancet 353 (1999): 793–796.

Guidelines Subcommittee, World Health Organization-International Society of Hypertension. "Guidelines for the Management of Hypertension." Journal of Hypertension 17 (1999): 151–183.

HANSSON, L.; LINDHOLM, L. H., NISKANEN, L.; LANKE, J.; HEDNER, T.; NIKLASON, A.; LUOMANMÄKI, K.; DALHÖF, B.; DE FAIRE, U.; MÖRLIN, C.; KARLBERG, B. E.; WESTER, P. O.; and BJÖRK, J-E. "Effect of Angiotensin-Converting-Enzyme Inhibition Compared with Conventional Therapy on Cardiovascular Morbidity and Mortality in Hypertension: The Captopril Project (CAPPP) Randomised Trial." Lancet 353 (1999): 611–616.

HANSSON, L.; LINDHOLM, L. H.; EKBOM, T.; DAHLÖF, B.; LANKE, J.; SCHERSTÉN, B.; WESTER, P. O.; HEDNER, THOMAS; and DE FAIRE, ULF. "Randomised Trial of Old and New Anti-hypertensive Drugs in Elderly Patients: Cardiovascular Mortality and Morbidity the Swedish Trial in Old Patients with Hypertension-2 Study." Lancet 354 (1999): 1751–1756.

KANNEL, W. B., and GORDON, T. "Evaluation of Cardiovascular Risk in the Elderly: The Framingham Study." Bulletin of the New-York Academy of Medicine 54 (1978): 573–591.

MRC WORKING PARTY. "Medical Research Council Trial of Treatment of Hypertension in Older Adults: Principal Results." British Medical Journal 304 (1992): 405–412.

SHEP COOPERATIVE RESEARCH GROUP. "Prevention of Stroke by Antihypertensive Drug Treatment in Older Persons with Isolated Systolic Hypertension. Final Results of the Systolic Hypertension in the Elderly Program (SHEP)." Journal of the American Medical Association 265 (1991): 3255–3264. "The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure." (JNC VI) Archives of Internal Medicine 157 (1997): 2413–2446.

STAESSEN, J. A.; FAGARD, R.; THIJS, L.; CELIS, H.; ARABIDZE, G. G.; BIRKENHÄGER, W. H. BULPITT, C.; DE LEEUW, W.; DOLLERY, C. T. FLETCHER, A. E.; FORETTE, F.; LEONETTI, G.; NACHEV, C.; O'BRIEN, E. T.; ROSENFELD, J.; RODICIO, J. L.; TUOMILEHTO, J.; and ZANCHETTI, A. "Randomised Double-Blind Comparison of Placebo and Active Treatment for Older Patients with Isolated Systolic Hypertension." Lancet 350 (1997): 757–764.

STAESSEN, J. A.; GAZOWSKI, J.; WANG, J. G.; THIJS, L.; DEN HONDE, E.; BOISSEL, J-P.; COOPE, JOHN; EKBOM, TORK; GUEYFFIER, FRANÇOIS; LIU, L.; KERLIKOWSKE, K.; POCOCK, S.; and FAGARD, R.. "Risks of Untreated and Treated Isolated Systolic Hypertension in the Elderly: Meta-Analysis of Outcome Trials." Lancet 355 (2000): 865–872.

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