Data from a program for hypertension screening and follow-up were used to study the relationship between age at onset of hypertension and the risk of cardiovascular complications. The risk for hypertensive subjects, compared with normotensive subjects of similar age, declined significantly as age of onset increased from 40 to 69 years. This pattern was not explained by differences in initial severity of hypertension, control of hypertension, obesity, smoking, or alcohol consumption. A sex-specific analysis showed that the pattern was confined to male subjects, but it is argued that it might be seen in female subjects if data for women of more advanced age were available. Further lines of investigation of this interesting phenomenon are proposed. (Hypertension 9: 204-208, 1987) KEY WORDS • hypertension • prognosis • age • geriatrics I T is well established that hypertension in the elderly is significantly related to cardiovascular morbidity and mortality.'• 2 What is not known is the prognosis of hypertension that begins in old age. Fra-mingham study observations of cardiovascular disease after age 65 years show a positive correlation between the number of years of elevated systolic pressure before age 65 years and the risk of disease thereafter. 3 These observations do not, however, allow a distinction to be made between age at onset and duration of hypertension. We have had an opportunity to examine the question by comparing the risk of cardiovascular disease among inception cohorts of hypertensive subjects according to their age at onset of hypertension. Subjects and Methods From 1978 to 1982, 34 general practices in southwestern Ontario took part in a trial of a system for improved detection and management of hypertension. 4 During this 5-year period, both fatal and nonfatal car-diovascular events were recorded for all patients aged 20 to 69 years. The events included myocardial infarc-tion, stroke, congestive heart failure, and renal failure (see Appendix at end of text). To investigate the relationship between age at onset of hypertension and the risk of cardiovascular events, we compared event rates among newly diagnosed hy-pertensive patients with rates among normotensive subjects of comparable age. Three cohorts of newly diagnosed hypertensive subjects who were aged 40 to 49, 50 to 59, and 60 to 65 years at the beginning of the 5-year period of observation were compared with nor-motensive cohorts in the same age groups at baseline (1978). The diagnosis of hypertension was made on the basis of a diastolic pressure of 90 mm Hg or greater on two consecutive office visits. The purpose of the study was to examine the effect of age at onset of hypertension, rather than that of age at diagnosis. Therefore, we included only the newly diagnosed hy-pertensive patients whose charts showed at least one previous normotensive blood pressure, no elevated pressures, and no record of treatment for hypertension in the 5-year period before baseline. In computing the rates of cardiovascular events, we included in the denomi...
It is a well established fact that anemic children are prone to infections. Moreover, the course of infections in such children is apt to be particularly severe. It is not uncommon for us to see the same poorly nourished. anemic child returning to the hospital or dispensary repeatedly, with recurrent infections of one or another part of the body. Anemic children are not only more prone to infectious processes but they appear to stand them poorly, and, as we are apt to say, seem to have a lowered resistance.We have observed a number of such infants, whose general condition was poor and whose blood revealed distinct secondary anemia, stricken with acute infections of the lung. In some, the pulmonary process appeared in the form of bronchopneumonia; in others, as lobar pneumonia. In some, the pneumonia was secondary to an upper respiratory infection, tonsillitis, pharyngitis and otitis ; in others, the pulmonary infection appeared to be primary, with the secondary appearance of other infectious foci, notably in the middle ear.The problem of the treatment of such children is extremely difficult. Even before the advent of the infectious process, they are a therapeutic problem. Proper feeding, hygiene and the administration of iron often have little or no effect. It happens frequently that when we are begin¬ ning with difficulty to make some progress in the cure of anemia, another infection takes hold of the child, the result of all our treatment is at once negatived, and if the child recovers from the infection we find the blood conditions even worse than before.It is in this difficult type of patient that I have seen some remarkable therapeutic results following blood transfusion.My attention was first drawn to this subject six years ago, when I had occasion to treat a child, aged 2 years, who was suffering from severe rickets and anemia and who developed lobar pneumonia. This child weighed 17 pounds (8.711 gm.), his hemoglobin was only 32 per cent, and the pulmonarv infection seemed about to cause his death. (For details see Case 1.) Though there were marked cyanosis, abdomi¬ nal distention. high fever and respirations of 86 per minute, a transfusion
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