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High Blood Pressure

Management Of Hypertension

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.



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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.

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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.

Additional topics

Medicine EncyclopediaAging Healthy - Part 2High Blood Pressure - Definition Of Hypertension, Blood Pressure Changes And Hypertension, Risk Of Hypertension, Benefits Of Antihypertensive Therapy - Nonpharmacologic interventions