Use of antihypertensive drugs and trends in blood pressure in the elderly

BACKGROUND: During the 1980s data became available from randomized trials concerning the clear benefits of treating hypertension in the elderly. In three large communities, we examined the impact of these findings on rates of treatment, use of specific antihypertensive drugs, and rates of elevated blood pressure as well as distributions of levels. METHODS: In 1981 the National Institute on Aging initiated population-based cohort studies in the residents of three communities who were 65 years and older. East Boston, Mass; Washington and Iowa counties, Iowa; and New Haven, Conn. Participation rates ranged from 80% to 85% across sites with 10,294 community-dwelling participants in the combined cohorts. Baseline evaluation included inhome blood pressure assessment and medication inventory. Repeated in-home evaluations occurred 3 and 6 years after baseline and follow-up rates ranged from 71% to 88%. RESULTS: Use of antihypertensive drugs increased over time in all three communities: the age- and sex-adjusted rates of use were between 14% and 32% higher in 1988 and 1989 relative to 1982 and 1983. Parallel declines in the use of thiazide diuretics occurred in all three populations along with large increases in the use of angiotensin-converting enzyme inhibitors and calcium channel blockers. In East Boston and New Haven mean systolic blood pressure decreased substantially over time and the prevalence of elevated systolic pressure (> or = 160 mmHg) decreased overall as well as by age and sex. In Iowa the mean levels of systolic blood pressure were lowest at baseline and increased slightly. CONCLUSIONS: The reported evidence about the benefits of treatment for hypertension in the elderly was followed by substantial increases in treatment rates. The use of drugs with proven efficacy declined while the use of newer agents with theoretical advantages, not yet tested in clinical trials of mortality, increased. In the United States, the ongoing therapeutic efforts to lower elevated blood pressure in elderly populations may be contributing to the continuing decline in cardiovascular and stroke mortality.     

Target blood pressure with antihypertensive therapy and 24-hour-RR measurement

In younger and middle-aged patients treatment should lower the blood pressure to below 140/90 mmHg and in the elderly aged 65 and more to 160/90 mmHg. Numerous interventional studies have shown that this can appreciably reduce the complications of hypertension. However, account must always be taken of the individual risk, so that in a particular case, it might be desirable to aim for lower values, for example, in diabetic nephropathy or when there is a summation of risks. The question as to whether there is a "point of reversal", that is, a renewed increase in complications associated with too great lowering of the blood pressure is still controversial. What is certain is that a lowering of blood pressure that is too rapid and too great can harm the patient with coronary or cerebral vascular stenoses. Better control of the blood pressure is enabled by the 24-hour blood pressure measurement by recording "office hypertension" or "office normotension", intermittent hypertensive or hypotensive phases and, in particular the nocturnal course of the blood pressure (no physiological dip/too pronounced dip).     

Association between blood pressure and dietary factors in the dietary and nutritional survey of British adults

During the last few decades, the industrial production and use of Cd resulted in the release of significant quantities of Cd into the environment. Concern about health risks of human exposure to this toxic metal, which may be contained in soil and other environmental compartments, has increased significantly in recent years. Soil ingestion is a potentially important pathway of exposure to soil-absorbed environmental contaminants, especially for young children exhibiting hand-to-mouth behavior. Health risk assessments are usually based on unchanged bioavailability of soil-absorbed pollutants, e.g., heavy metals, neglecting interactions of metals with the soil matrix, which may lead to relatively lower bioavailability. This study was conducted to determine the bioavailability of Cd absorbed to soil in rats. Eight-week-old male Lewis rats were given either a soil polluted with CdCl2 (150 micrograms Cd/rat) dissolved in 5% gun acacia or an equal amount of Cd as CdCl2 dissolved in saline. Control rats were gavaged with isotonic saline. Cd concentrations in liver, kidney, brain, heart, and blood, as well as Cd content of urine and feces were analyzed using graphite furnace atomic absorption spectrometry. Tissue Cd concentrations in soil-treated animals were significantly lower than the tissue concentrations in the Cd-saline group; in the liver and kidneys of the Cd-saline and Cd-soil groups, 4 and 2.7% respectively, of the original doses were recovered. Relative bioavailability, calculated on the basis of blood Cd levels for the Cd-soil group as compared to the Cd-saline group, appeared to be 43%. No differences in the excretion pattern of Cd into feces were observed between the Cd-saline and Cd-soil groups. After 6 days, over 91% of the original dose was recovered in the feces of both Cd-treated groups. Cd excretion via urine was very low, but in the Cd-soil group a significant increase in urinary Cd was observed as compared to the control group. However, the amount of Cd excreted into urine of the Cd-soil group during the experimental period corresponded to only 0.01% of the original dose. In the Cd-saline group, no additional Cd was excreted into urine as compared to the control group. These results indicate that the soil matrix significantly reduced the absorption of Cd in the gastrointestinal tract. Consequently, exposure assessment models, assuming an unaffected bioavailability of soil-absorbed Cd, overestimate the internal dose and thereby overestimate health risks associated with direct ingestion of soil particles.     

Association between insulin and blood pressure in relation to the influence of body mass index

The relationship between plasma insulin level and systolic blood pressure (SBP) was investigated by multiple linear regression procedure in 410 Chinese non-diabetics. The significant positive correlation between SBP and 2-hour plasma insulin (INS 2h) after 75g glucose load was found in the BMI (body mass index) 15.9-27.0 group (n = 287) after the adjustment for age, sex, BMI, smoking and plasma cholesterol (P = 0.01). However, this significant correlation was gradually diminished with the expansion of the BMI range, ie. P = 0.04 in the BMI 15.9-29.0 (n = 356) group, P = 0.07 in the BMI 15.9-31 (n = 389) group, and P = 0.12 in the BMI 15.9-33 (n = 402) group after the same adjustment of variables. Interestingly, the significant inverse correlation between insulin-BMI interaction term (product of BMI and insulin) and SBP was found (P = 0.04) in the presence of the significant positive correlation between 2-hour plasma insulin and SBP (P = 0.02) after adjustment of the above mentioned five factors in the whole group (BMI 15.9-42.2, n = 410). These results indicated that SBP is independently correlated with plasma insulin level in the studied population, and that the severer obesity may interfere the net effects of insulin on the elevating of blood pressure.     

Relationship between end-systolic aortic pressure and mean aortic pressure in adults

The mean blood pressure is an accurate estimate of the end-systolic aortic pressure in children. The aim of this study was: 1) to assess the relationship between the pressure at the incisura (PIAo) and the mean (MAoP) and pulse (PAoP) pressures of the supravalvular aorta in adults: and 2) to evaluate MAoP as an estimate of PIAo in adults. High fidelity pressure recordings were carried out in the supravalvular aorta in 17 men. The pressures were measured at rest in 10 consecutive beats and. In 6 subjects, during a Valsalva manoeuvre. At rest, PIAo was greater than the MAoP (109 +/- 17.9 versus 99.6 +/- 12.5 mmHg, p = 0.0001). There was a positive linear correlation between PIAo and MAoP (r = 0.93) and between PIAo and PAoP (r' = 0.77) whereas no correlation was observed between PIAo and heart rate, cardiac output or estimated total systemic arterial compliance. A beat-to-beat relationship was observed between PIAo and MAOP: 1) at rest in 16 of the 17 subjects and 2) in each subject who performed a Valsalva manoeuvre. Both at rest and during Valsalva, MAOP underestimated PIAo significantly, especially when PIAo was increased (p = 0.0001). The authors conclude that end-systolic supraaortic pressure is mainly related to the mean component of aortic pressure. MAOP slightly but constantly underestimated PIAo and this should lead to caution in assimilating MAOP to end-systolic aortic pressure in adults, especially in subjects with very high aortic pressures.     

Lamotrigine plasma concentrations in children and adults: influence of age and associated therapy

The het-e gene of the filamentous fungus Podospora anserina is involved in vegetative incompatibility. Co-expression of antagonistic alleles of the unlinked loci het-e and het-c triggers a cell death reaction that prevents the formation of viable heterokaryons between strains that contain incompatible combinations of het-c and het-e alleles. The het-elA gene encodes a polypeptide that contains a putative GTP-binding site and WD40 repeats. The role of these two domains in the reactivity of the HET-E protein in incompatibility was analyzed. An in vitro assay confirmed that the first domain is functional and can bind GTP and not ATP, suggesting that GTP-binding is essential for triggering the incompatibility reaction. The relationship between the number of WD40 repeats and the reactivity of the protein in incompatibility was investigated by estimating this number in different wild-type and mutant het-e alleles. It was deduced that reactive alleles contain a minimal number of ten WD40 repeats. These results demonstrate that the reactivity of the HET-E protein depends on two functional elements, a GTP-binding domain and several WD40 repeats. These motifs are present in separate polypeptides in trimeric G proteins, suggesting that HET-E polypeptides are also involved in signal transduction. Disruption of the het-e locus does not impair the phenotype of strains but DNA hybridization analyses revealed that het-e may belong to a multigenic family.     

The Solution Method: 2-year trends in weight, blood pressure, exercise, depression, and functioning of adults trained in development skills

This study describes changes observed during a 2-year period in participants enrolled in The Solution Method, a developmental skills training program for adult weight management. This intervention is the adult application of a model of treatment previously used only in the management of pediatric obesity (The Shapedown Program). Developmental skills training integrates understandings and methods from developmental, family systems, biomedical, genetic, and behavioral theories of the etiology of obesity. Twenty-two subjects (mean age = 43.4 +/- 8.5 years and mean body mass index = 33.1 +/- 5.3) completed a group intervention based on this method, which was conducted by a registered dietitian and a mental health professional. Questionnaire responses indicated the extent to which their weight was a medical and/ or psychosocial risk. Subjects attended 2-hour weekly sessions for an average of 18 weeks during which they were trained in six developmental skills: strong nurturing, effective limits, body pride, good health, balanced eating, and mastery living. Data, which were collected at the beginning of treatment and at 3, 6, 12, and 24 months, included weight, blood pressure, 7-day exercise recalls, and responses to depression and functioning (psychosocial, vocational, and economic) questionnaires. Participants' weights decreased throughout the 2-year period of the study: mean weight change was -4.2 kg (3 months), -6.0 kg (6 months), -7.0 kg (12 months), and -7.9 kg (24 months). In addition, compared with baseline values, systolic and diastolic blood pressure, exercise, and depression improved throughout the study period. These improvements were statistically significant at 24 months for weight (P < .01), systolic blood pressure (P < .02), diastolic blood pressure (P < .001), and exercise (P < .001); the results were not statistically significant for depression. Most participants reported improvement in a broad range of aspects of functioning. We conclude that this application of developmental skills training for adult weight management may produce significant long-term beneficial effects.     

The influence of 5-week relaxation therapy on arterial blood pressure in patients with borderline hypertension

The present study was performed to evaluate the influence of 5-week relaxation therapy on office and ambulatory blood pressure in young borderline hypertensives. Thirty patients were studied. The office blood pressure decreased significantly after 5 weeks of relaxation therapy (P < 0.001 for both systolic and diastolic blood pressure). Ambulatory monitoring revealed only a slight decrease of 24-hour blood pressure (P = 0.02). Our results indicate limited efficacy of relaxation therapy in treatment of borderline hypertensives.     

Effects of antihypertensive drugs on blood pressure and metabolic alterations in the fructose-induced hypertensive rat

Fructose feeding induces a moderate increase in blood pressure (BP) levels in normal rats, which is associated with insulin resistance, hyperinsulinemia, and hypertriglyceridemia. Increased vascular resistances in skeletal muscle have been proposed to contribute to BP elevation and insulin resistance in this animal model. To further explore the mechanisms underlying the fructose-induced hypertension in rats, the effects of quinapril and diltiazem on BP, renal function, plasma levels of glucose, insulin, and triglycerides, and insulin resistance were studied. Male Sprague-Dawley rats were fed for 4 weeks with diets containing 60% fructose or 60% starch and received quinapril or diltiazem in the drinking water. Fructose-fed rats showed higher BP and plasma levels of insulin and triglycerides when compared to controls. Treatments with quinapril or diltiazem prevented BP elevation and reduced elevated plasma insulin levels in fructose-fed rats. Plasma glucose and insulin levels were higher (P < .05) in fructose-fed rats than in controls at 15, 30, and 60 min after oral glucose load. Treatments with either quinapril or diltiazem prevented the exaggerated plasma insulin and glucose levels in response to oral glucose load in fructose-fed rats. In summary, both quinapril and diltiazem were able to prevent BP elevation levels in the fructose-fed rat, and reduced the exaggerated response to an oral glucose tolerance test in these animals.     

Normal values for ambulatory blood pressure and differences between casual blood pressure and ambulatory blood pressure: results from a Danish population survey

Oncogenic forms of the Abl and Src tyrosine kinases trigger the destruction of the Abi proteins, a family of Abl-interacting proteins that antagonize the oncogenic potential of Abl after overexpression in fibroblasts. The destruction of the Abi proteins requires tyrosine kinase activity and is dependent on the ubiquitin-proteasome pathway. We show that degradation of the Abi proteins occurs through a Ras-independent pathway. Significantly, expression of the Abi proteins is lost in cell lines and bone marrow cells isolated from patients with aggressive Bcr-Abl-positive leukemias. These findings suggest that loss of Abi proteins may be a component in the progression of Bcr-Abl-positive leukemias and identify a novel pathway linking activated nonreceptor protein tyrosine kinases to the destruction of specific target proteins through the ubiquitin-proteasome pathway.     

The provision of renal replacement therapy for adults in England and Wales: recent trends and future directions

We assessed the level of provision of renal replacement therapy for adults in England and Wales. All autonomous main renal units in England (n = 52) and Wales (n = 5) were surveyed in 1996. Data for England were compared to the 1993 National Renal Review. The acceptance rate in England 1995 was 82 (80-85) per million population (p.m.p.) compared with 67 (65-70) p.m.p. in 1991-2. The rate in 1995 in Wales was 109 (98-122) p.m.p. The prevalence rate in England was 476 p.m.p. at end-1995 compared to 393 p.m.p. in 1993, in Wales it was 487 p.m.p. The number of main renal units in England did not rise between 1993 and 1995; capacity was increased by use of more treatment shifts and temporary haemodialysis stations, and by opening more satellite units. The main growth was in hospital haemodialysis. There was an uneven geographical distribution of services. Patients accepted were older with more comorbidity. The use of better-quality processes of dialysis increased. The steady-state position for RRT will not be reached for over a decade. Health authorities will face continued pressure to fund increases in quantity and quality improvements. A stronger evidence base of the effectiveness of therapies, and a national registry to monitor the equity and cost-effectiveness of services are needed.     

Ten-year blood pressure trends in nonhypertensive inhabitants of La Plata, Argentina

OBJECTIVES: To compare, according to blood pressure (BP) categories, 10-year trends in BP measurements in nonhypertensive subjects and the relative risk of developing hypertension. DESIGN: Population study. BP was recorded as the average of two measures taken on a single occasion with a mercury sphygmomanometer and the auscultation method. SETTING: Residents of La Plata, aged 15 to 64 years. PARTICIPANTS: The study was based on randomly chosen individuals who, during a previous survey in 1985, were 15 to 64 years old and whose BP was below 140/90 mmHg. They were grouped according to sex and BP categories. Random age- and sex-stratified sampling of 151 men and 193 women was performed. Categories were high normal BP, optimal BP (as defined by the fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure) and normal but not optimal BP defined as BP 120 to 129/80 to 84 mmHg. RESULTS: BP increased in all categories; this increase was significant (P < 0.01) except for diastolic BP in women with high normal BP. BP increases were higher in optimal BP subjects and lower in high normal BP subjects (P < 0.01 for women and not significant for men). The relative risk of developing hypertension in high normal BP subjects was triple that in optimal BP subjects (P < 0.01). CONCLUSIONS: Increases in BP observed in optimal BP subjects stress the importance of monitoring BP changes and recommending primary prevention in the whole population.     

New trends in the drug therapy of localized and disseminated Mycobacterium avium complex infection

Recent advances in the drug therapy of localized and disseminated infection with Mycobacterium avium complex (MAC) are reviewed. MAC infection is the most commonly reported bacterial infection in patients with AIDS, and the frequency of this infection in patients negative for the human immunodeficiency virus (HIV) is increasing. The main portals of entry for MAC are the gastrointestinal and respiratory tracts. Localized MAC infection is more common in HIV-negative than HIV-infected patients. The symptoms of disseminated MAC disease are those typical of advanced HIV disease. The most reliable diagnosis is provided by blood cultures; radiometric culturing techniques are favored. The overall treatment of MAC infection has improved greatly with the introduction of new agents during the past 15 years; survival time has been extended. Clarithromycin and azithromycin have proven effective against both localized and disseminated MAC infection. Clarithromycin is the cornerstone of therapy for disseminated infection. Ciprofloxacin has been successfully used to treat disseminated infection as part of a four-drug regimen including rifampin, ethambutol, and clofazimine. Rifabutin has substantial efficacy when combined with other agents. Liposomal aminoglycosides, such as amikacin, and interferon gamma have shown some initial promise. Rifabutin is currently recommended for the prevention of MAC disease in HIV-infected patients. Clarithromycin and azithromycin have also shown efficacy for prophylaxis, and fluoroquinolones may play a preventive role as well. New drug therapies are improving the outlook for persons infected with MAC.     

Racial discrimination and blood pressure: the CARDIA Study of young black and white adults

OBJECTIVES: This study examined associations between blood pressure and self reported experiences of racial discrimination and responses to unfair treatment. METHODS: Survey data were collected in year 7 (1992/93) of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a prospective multisite community-based investigation. Participants included 831 Black men, 1143 Black women, 1006 White men, and 1106 White women 25 to 37 years old. RESULTS: Systolic blood pressure among working-class Black adults reporting that they typically accepted unfair treatment and had experienced racial discrimination in none of seven situations was about 7 mm Hg higher than among those reporting that they challenged unfair treatment and experienced racial discrimination in one or two of the situations. Among professional Black adults, systolic blood pressure was 9 to 10 mm Hg lower among those reporting that they typically challenged unfair treatment and had not experienced racial discrimination. Black-White differences in blood pressure were substantially reduced by taking into account reported experiences of racial discrimination and responses to unfair treatment. CONCLUSIONS: Research on racial/ ethnic distributions of blood pressure should take into account how discrimination may harm health.     

Relationship between blood pressure and stress-prone temperament in dogs

As part of an assessment of stress during the training of guide dogs for the blind, blood pressures have been monitored in their main breeds. For this article a population of 227 Labradors, between 9 and 24 months of age, had indirect arterial blood pressures measured and means taken of five readings. They were ranked according to their pressures. Prior to the measurements, their character was independently assessed as "stress-prone" or "non-stress-prone" by their highly experienced and trained handlers. The pressure data distribution of stress-prone animals in the ranking was analysed; they were significantly more likely to be found at the high end of the blood pressure range for that population.     

Loneliness predicts increased blood pressure: 5-year cross-lagged analyses in middle-aged and older adults.

Loneliness is a prevalent social problem with serious physiological and health implications. However, much of the research to date is based on cross-sectional data, including our own earlier finding that loneliness was associated with elevated blood pressure (Hawkley, Masi, Berry & Cacioppo, 2006). In this study, we tested the hypothesis that the effect of loneliness accumulates to produce greater increases in systolic blood pressure (SBP) over a 4-year period than are observed in less lonely individuals. A population-based sample of 229 50- to 68-year-old White, Black, and Hispanic men and women in the Chicago Health, Aging, and Social Relations Study was tested annually for each of 5 consecutive years. Cross-lagged panel analyses revealed that loneliness at study onset predicted increases in SBP 2, 3, and 4 years later (B = 0.152, SE = 0.091, p     

Recent trends in drug delivery systems: liposomal drug delivery system--preparation and characterisation

The strong relation between increased left ventricular mass and cardiovascular events makes accurate measurement of left ventricular mass a high priority, especially in patients with hypertension. M-mode echocardiography is used most widely to measure left ventricular mass because of its wide availability, moderate expense, anatomic and prognostic validation and lack of radiation or claustrophobia; however, this technique is expertise-dependent and may give erroneous results in distorted ventricles. Two-dimensional and especially three-dimensional echocardiography increase the precision with which left ventricular mass is measured but they are more time-consuming and difficult to perform on a large scale. Magnetic resonance imaging provides highly accurate left ventricular mass measurements and permits tissue imaging but its use is limited by expensive, fixed facilities and claustrophobia. Cine computed X-ray tomography also measures left ventricular mass accurately and permits perfusion assessment with contrast injection but it involves radiation and the use of fixed facilities of limited availability. Understanding the strengths and limitations of available techniques can facilitate selection of the most appropriate method to measure left ventricular mass in a particular setting.     

Does the choice of antihypertensive therapy influence haemodynamic responses to induction, laryngoscopy and intubation?

We have measured haemodynamic responses to induction of anaesthesia, laryngoscopy and intubation in 103 mild-moderate hypertensive patients (83 patients (diastolic pressures < or = 110 mm Hg) currently receiving one of four monotherapies (ACE inhibitors, group A; beta adrenoceptor blocking drugs, group B; calcium channel antagonists, group C; diuretics, group D) and 24 were untreated hypertensive patients). Anaesthesia was induced with fentanyl 1.5-2.0 micrograms kg-1 and thiopentone 3-5 mg kg-1. Tracheal intubation was facilitated by vecuronium 0.1 mg kg-1 and anaesthesia maintained with enflurane and nitrous oxide in oxygen. Systolic and diastolic pressures (SAP, DAP) were measured at 1-min intervals by a non-invasive oscillometric method and cardiac output (CO) and stroke volume (SV) by thoracic bioimpedance. Induction of anaesthesia was associated with a decrease in SAP, DAP and CO in groups A-D (P < 0.05). Heart rate (HR) decreased in groups A and D (P < 0.01) and systemic vascular resistance (SVR) decreased in groups A and B (P < 0.05). SAP and HR increased in all groups after laryngoscopy and intubation (P < 0.01) as did SVR in groups A, B and D (P < 0.02). CO was unaltered. Similar changes occurred in the untreated hypertensive patients, although nine of 24 patients exhibited HR > or = 100 beat min-1 after laryngoscopy and intubation. Comparison of the changes in SAP, DAP, CO and SVR with time showed no differences in the five treatment groups; changes in HR were significantly less in group B compared with the other groups (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)