YOU ARE NOW CONNECTED TO THE TOXLINE (1981 FORWARD, NON-ROYALTY) FILE. ==BLOOD PRESSURE - SYSTOLIC== 20 AUTHOR Cressman MD AUTHOR Gifford RW Jr TITLE Controversies in hypertension: mild hypertension, isolated systolic hypertension, and the choice of a step one drug. SOURCE Clin Cardiol; VOL 6, ISS 1, 1983, P1-10 ABSTRACT The realization that cardiovascular morbidity and mortality increases in patients with mild elevation of either systolic or diastolic blood pressure has led to a consideration to treat millions of patients with mild diastolic or isolated systolic hypertension. The cost of administering a successful antihypertensive treatment program and the potential adverse effects of pharmacologic agents is of great concern. It has been emphasized that the risk of premature mortality differs in individual patients according to the number of associated cardiovascular risk factors at any level of blood pressure. This has led to a suggestion that only high risk patients be treated. However, a significant number of low risk patients with mild hypertension develop a more severe or complicated form of their disease even over a follow-up period of five to ten years. There is no good way to identify these patients. Trials of antihypertensive therapy suggest a beneficial effect of blood pressure lowering in mild hypertension. No trials of antihypertensive therapy in elderly patients with isolated systolic hypertension have been reported, but the elevation in systolic blood pressure appears to be an independent risk factor for cardiovascular mortality. Even the choice of the first step agent in treatment is debatable. Diuretics or beta blockers effectively lower blood pressure in the majority of hypertensive patients, particularly if modest dietary sodium restriction is achieved. The incidence of side effects, either symptomatic or biochemical, is similar but diuretics are unquestionably cheaper and probably more effective. Successful application of an antihypertensive treatment program may continue to reduce our unacceptably great incidence of cardiovascular disease. 10 AUTHOR Opie LH TITLE Treatment of hypertension in the elderly--the end of the story? [editorial] SOURCE Cardiovasc Drugs Ther; VOL 6, ISS 6, 1992, P559-62; discussion 563-4 (REF: 19) ABSTRACT The elderly constitute a high-risk group in which the benefit of treatment of hypertension is now obvious. The initial drug should be a low-dose diuretic, followed by a beta-blocker. At present there are no data favoring the use of an ultra low-dose diuretic, such as 12.5 mg hydrochlorothiazide, unless there is coexisting prediabetes or gout. 4 AUTHOR Avanzini F AUTHOR Alli C AUTHOR Bettelli G AUTHOR Corso R AUTHOR Colombo F AUTHOR Mariotti G AUTHOR Radice M AUTHOR Torri V AUTHOR Tognoni G TITLE Antihypertensive efficacy and tolerability of different drug regimens in isolated systolic hypertension in the elderly. SOURCE Eur Heart J; VOL 15, ISS 2, 1994, P206-12 ABSTRACT The pharmacological treatment, mainly based on diuretics, of isolated systolic hypertension (ISH) has recently been shown to reduce the risk of stroke and coronary heart disease in the elderly. The purpose of this study was to compare the antihypertensive effect and tolerability of different drug regimens in elderly subjects with ISH (systolic blood pressure--SBP-- > or = 160 mmHg and diastolic blood pressure--DBP-- < 90 mmHg). A multicentre, randomized, controlled open trial was planned in the general practice setting. Four widely used treatment schedules were tested: hydrochlorothiazide 25 mg plus amiloride 2.5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol 50 mg (At) and atenolol 25 mg plus chlorthalidone 6.25 mg (At+C). After a baseline evaluation, 308 patients (76.3% female, mean age 75.3 +/- 7.1 years) were randomized and followed up for 6 months. After 3 months the drug dosage was doubled if the systolic blood pressure goal (SBP < 160 mmHg and SBP reduction of at least 20 mmHg) had not been reached. Ninety-four subjects (30.5%) presented contraindications to beta-blockers. At the 3rd- and 6th-month visits all treatment groups, except At, showed a significant reduction in SBP compared to the control group; DBP showed no significant reduction in any group at any time. At the end of the follow-up the percentage of hypertensives who had reached the BP goal was 14.6% in the control group, 52.9% in H+Am, 54.8% in N, 28.6% in At and 52.2% in At+C.(ABSTRACT TRUNCATED AT 250 WORDS) 7 AUTHOR Cushman WC AUTHOR Khatri I AUTHOR Materson BJ AUTHOR Reda DJ AUTHOR Frye C AUTHOR et al TITLE Treatment of hypertension in the elderly. Part 3. Response of isolated systolic hypertension to various doses of hydrochlorothiazide: results of a Department of Veterans Affairs Cooperative Study SOURCE Arch. Intern. Med.; VOL 151 ISS Oct 1991, P1954-1960, (REF 28) ABSTRACT IPA COPYRIGHT: ASHP A randomized, double blind study evaluating the therapy of isolated systolic hypertension (ISH) was conducted in 51 male patients, mean age 68.9 yr, who were given 25 or 50 mg/day of hydrochlorothiazide; the dosage could be halved or doubled to achieve blood pressure control during the first 10 wk, and the patients were then followed at that dose for another 24 wk. The reductions in blood pressure and proportion of patients in whom blood pressure was controlled were similar in the lower and higher dose groups during the titration phase. However, serum potassium level was reduced more in the higher dosage group than in the lower dosage group. There were no significant changes in blood pressure during the maintenance phase. No patient required withdrawal from the study because of adverse effects, and cognitive-behavioral function was well preserved. It was concluded that hydrochlorothiazide is effective and well tolerated in older patients with ISH, many of whom may be effectively treated with 25 mg of hydrochlorothiazide once daily. 13 AUTHOR Cushman WC AUTHOR Khatri I AUTHOR Materson BJ AUTHOR Reda DJ AUTHOR Freis ED AUTHOR Goldstein G AUTHOR Ramirez EA AUTHOR Talmers FN AUTHOR White TJ AUTHOR Nunn S AUTHOR et al TITLE Treatment of hypertension in the elderly. III. Response of isolated systolic hypertension to various doses of hydrochlorothiazide: results of a Department of Veterans Affairs cooperative study. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. SOURCE Arch Intern Med; VOL 151, ISS 10, 1991, P1954-60 ABSTRACT In a double-blind randomized study, we evaluated the effects of 25 mg vs 50 mg of hydrochlorothiazide in 51 elderly patients (aged 68.9 +/- 7.0 years) with isolated systolic hypertension (blood pressure, 160 to 239 mm Hg systolic and less than 90 mm Hg diastolic). Dose levels could be increased to twice daily to control blood pressure. The reductions in blood pressure (25.4/6.8 mm Hg and 28.9/7.4 mm Hg) and proportion of patients in whom blood pressure was controlled (78% and 89%) were similar in the lower- and higher-dose groups during the titration phase. However, serum potassium level was reduced more in the higher-dosage (0.57 mmol/L) than the lower-dosage (0.17 mmol/L) group. There were no significant changes in blood pressure during a 24-week maintenance phase. No patient required withdrawal from the study because of adverse effects, and cognitive-behavioral function was well preserved. We conclude that hydrochlorothiazide is effective and well tolerated in older patients with isolated systolic hypertension, many of whom may be effectively treated with 25 mg of hydrochlorothiazide once daily.