Treatment Of Elevated Blood Pressure Research Articles

Determinants of elevated blood pressure in women around menopause: results from a cross-sectional study in Italy

Objective: To analyse the determinants of high blood pressure in women around menopause. Methods: Eligible women were consecutively identified among patients who asked for a visit of their general practitioner during the period March–November 1997. A total of 22 919 women aged 44–66 years (median age 55 years), were identified. Women whose mean of the second and third of the three measures of diastolic blood pressure values performed during interview was >90 mm of mercury and/or reporting any type of current pharmacological treatment for elevated blood pressure were considered hypertensive. Results: In comparison with women aged 40–50 years, the multivariate odds ratio (OR) of elevated blood pressure were 1.4 in women aged 51–55, 2.0 in those aged 56–60 and 2.7 in those aged ≥61. In comparison with women with a body mass index (kg m −2) <25, the OR of elevated blood pressure was 1.7 and 2.7, respectively, for women with a BMI of 25–28 and ≥29. In comparison with women reporting a low level of physical activity, the OR of elevated blood pressure were 0.9 (95%, confidence interval, CI 0.7–1.0) and 0.7 (95% CI 0.4–0.9), respectively, for those reporting an intermediate or high level of activity. In comparison with premenopausal women, the OR of elevated blood pressure was, after taking into account the confounding effect of age, 1.6 (95% CI 1.0–1.4) in post menopausal ones. The OR of elevated blood pressure was 0.8 (95% CI 0.7–0.9), for current users of hormone replacement therapy (HRT), but no clear association emerged with duration of HRT pressure. Conclusions: This study suggests that, after taking into account the effect of age, post-menopausal women are at higher risk of the condition, and current HRT use decreases the risk. Other main determinants of risk of elevated blood pressure were overweight and low physical activity.

Effect of medical therapy on progressive nephropathy: influence of pregnancy, diabetes and hypertension.

Nephropathy is a complication of diabetes mellitus that can affect women in their reproductive years. This article reviews the effects on treatment on the main factors associated with short- and long-term complications in pregnant women with diabetic nephropathy. Tight glycemic control, adequate treatment of elevated blood pressure, and renal function in early pregnancy are the most significant predictors of maternal and perinatal outcomes. Contemporary methods of perinatal care and adequate treatment of blood pressure allow fetal survival rates of 95%. Furthermore, pregnancy per se does not appear to worsen the natural progression to end-stage renal disease for most women with renal insufficiency. However, patients with moderate to severe renal impairment may experience acceleration of renal disease.

Diabetic nephropathy.

Renal involvement is one of the major microvascular complications of both type 1 and type 2 diabetes mellitus. Diabetic nephropathy is the major cause of end-stage renal failure in most Western nations and is associated with increased morbidity and mortality as compared to other causes of renal disease. The pathogenesis of renal involvement in diabetes is presumed to be the result of the interplay of metabolic and hemodynamic factors. Significant advances in the prevention and treatment of progression of diabetic nephropathy have been achieved with intensive glycemic control and the treatment of elevated blood pressure. Patients with diabetes should thus be screened regularly for the appearance of any of the risk factors for renal or other complications and treated intensively according to established guidelines for control of hyperglycemia and hypertension. Ancillary therapeutic measures include treatment of hyperlipidemia, low-protein diet, and the cessation of smoking.

49-Year-Old Woman With Chest Pain

49-Year-Old Woman With Chest Pain

HYPERTENSION IN THE ELDERLY

The decade of the 1990s has clarified the perspective on treating hypertension in the elderly and provided a wealth of evidence to assist in the treatment of elevated blood pressure in older persons. Despite this wealth of information, important questions remain about treatment of hypertension in the elderly.

Treatment of elevated blood pressure in diabetic patients

rterial hypertension is a major contributor to A the secondary complications of diabetes. Moreover, prevention or treatment of hypertension reduces the incidence and progression of diabetic complications. In May 1993 the American Diabetes Association sponsored a Consensus Development Conference to emphasize the importance of detection and managment of hypertension in diabetes.’ The panel attempted to reach a consensus on an answer to the question: “What are the treatments for hypertension in diabetes, and what can be accomplished by treatment?” Consensus was reached concerning lifestyle modifications as the foundation of diabetic and hypertension management (Table 1).

Soluble fiber and hypertension.

Hypertension is the most prevalent cardiovascular disorder in the United States. As many as 50 million people in this country have had elevated blood pressure diagnosed.1–3 Elevated blood pressure has been linked to an increased incidence of stroke and coronary heart disease.4,5 Treatment of elevated blood pressure decreases the associated mortality and morbidity, and control of hypertension has contributed substantially to a 57% decline in mortality from stroke and 50% in that from coronary heart disease from 1972 to 1990.1 A reduction in average population diastolic blood pressure of 5 mmHg would be expected to reduce the incidence of stroke by about one-third, resulting in the prevention of 100,000 strokes in the U.S. each year.6

Managing hypertension in the elderly: dispelling the myths.

There are now more than 31 million people 65 years of age or older in the United States, at least half of whom have systolic blood pressure 140 mm Hg or higher or diastolic blood pressure 90 mm Hg or higher or both. By the year 2050, 16 million Americans will be over age 85. To review the current data and recommendations regarding treating hypertension in elderly patients. Randomized clinical trials have dispelled some of the myths that surround treatment of hypertension in the elderly by showing that judicious treatment of elevated blood pressure, both systolic and diastolic, will reduce the risk of cardiovascular morbidity and mortality, with an acceptable trade-off in terms of side effects and without sacrificing quality of life. Because most of the trials have used a diuretic as initial therapy, it is recommended that one of these agents be prescribed in low doses if life-style modifications do not reduce blood pressure to acceptable levels, unless there is a contraindication to diuretics or an indication for another class of agents.

Treatment of hypertension in diabetic men: Problems with sexual dysfunction

Hypertension occurs 2 to 3 times more frequently in diabetic persons than in nondiabetic persons. Care must be taken in treating hypertension in diabetic patients because the choice of antihypertensive agent may worsen the diabetic state or its complications or cause additional health problems for the patient. Sexual dysfunction is a common problem in diabetic patients; however, diabetes need not be the cause. Diabetic men with hypertension have an increased sensitivity to the side effect of sexual dysfunction, which occurs from the use of centrally acting antihypertensive agents. By using prazosin, an α 1-adrenergic blocking agent, this cause of sexual dysfunction was eliminated. The reasons for the increased prevalence of hypertension in diabetic patients are discussed and a rational approach is given for the treatment of elevated blood pressure in these individuals.

Behavioral Treatment of High Blood Pressure: III. Follow-Up Results and Treatment Recommendations

This article is the third in a series of studies designed to evaluate systolic blood pressure biofeedback and relaxation in the treatment of elevated blood pressure. It reports on the posttreatment follow-up results. The main findings were that patients who received the behavioral treatments could achieve and sustain reductions in blood pressure for at least 18 months. Furthermore, a number of patients who were receiving diuretic therapy to control their pressures were able to maintain reduced pressure for at least 9 months after discontinuing medication. A model for a behavioral-stepped care program is proposed.

Automatic control of blood pressure by drug infusion

Automatic control of arterial blood pressure by infusing the drug sodium nitroprusside is used for the treatment of elevated blood pressure after open-heart surgery at the Cardiac Surgical Intensive Care Unit of the University of Alabama Hospital. Controller design was based on investigations of the dynamics of the physiological responses of patients to nitroprusside infusion. A nonlinear PID digital controller has been used on over 1700 patients. Clinical experiences have shown that automatic control is safe and effective. The wide range of patient characteristics we have observed warranted the design of an improved controller.For analysis, design and evaluation, a model of the system related to arterial pressure and its response to nitro prusside was developed, and patient care practices were analysed. An adaptive multiple-mode multirate sampled-data controller was designed using model-based techniques, and was implemented with a microcomputer system. Simulation results were verified by experiments in the animal laboratory. Results from clinical evaluations with postsurgical patients were superior to the performance of previous automated infusion systems.

A Model for Design of a Blood Pressure Controller for Hypertensive Patients

Various closed loop control systems have been used to automate the infusion of the drug sodium nitroprusside for treatment of elevated blood pressure frequently observed in the early hours following open heart surgery. Clinical experience indicates a need for an improved controller which adapts to each patient and his changing condition. For system design, analysis, and evaluation, a model of the essential aspects of the arterial blood pressure and its response to nitroprusside is necessary. The model was structured using patient measurement data together with a priori knowledge of physiological concepts and the pharmacological action of the drug. The arterial pressure is considered the sum of nonstationary stochastic background activity and a change due to the nitroprusside (characterized by a transfer function). The model was applied to the simulation of a clinically used controller and has provided insight into responses observed in the treatment of over 700 patients. The model is presently being used for computer-aided design and evaluation of an adaptive controller. Simulations of a preliminary adaptive transient controller and regulator demonstrated improved performance over the clinically used controller.

A simple feedback system for the treatment of elevated blood pressure

A relatively simple, open-loop feedback system for use in teaching patients with elevated blood pressure to lower their blood pressure is described. It is based on once per minute determinations of blood pressure which are read by the experimenter and then presented to the patient by closed circuit television. The procedure is reliable and trouble free. Four single subject design experiments are described in which the elevated systolic blood pressures of four patients suffering from essential hypertension or borderline hypertension were lowered to the normal range. Decrease in blood pressure ranged from 9 to 55 millimeters of mercury. Control conditions in each experiment indicate that the feedback procedure was responsible for the lowering of blood pressure.