Diminished efficacy of each additional antihypertensive agent administered to patients $ge;60 years of age compared to younger patients

Abstract

Hemodialysis (HD) patients (pts) in a teaching hospital and freestanding outpatient dialysis setting were enrolled to determine the relationship between risk factors and thromboembolic events (TE) in a high-risk population. 58 HD pts: 44 diabetic [DM]; 20 type 1 (DM1), 24 type 2 (DM2); 14 non-DM had data collected for prior TE, C-reactive protein (CRP), antihypertensive medication classes (medcl), beta blocker (BB), antiangiotensin drug use (AAD) use and pre-HD blood pressure (BP) measurement. We hypothesized that choice of medcl, attainment of target BP, and degree of inflammatory activation would be related to the presence or absence of prior TE.Results: At entry into the study DM HD pts were more likely to have a prior history of TE than non-DM (59, 21%, pϭ0.030) and more likely to have received anti-angiotensin drugs [AAD] (52, 14%, pϭ0.015). However, a prior history of TE was not associated with a difference in BP control or use of AAD. Target systolic BP of 121-140 was attained in only 31% of pts; 62%Ͼ140; 7% Յ120mmHg prior to HD on the day of enrollment. Mean medcl for DM1: 1.5 Ϯ 0.3, DM2: 1.8Ϯ0.2, and non-DM: 1.8Ϯ0.2, respectively (p ϭ ns). Mean systolic BP was 152Ϯ7, 152Ϯ7, 148Ϯ10 (pϭns). For type 2 DM HD pts, there were positive correlations between BP and number of medcl (rϭ 0.559, pϭ0.005); between BP and Crp (rϭ-0.442, pϭ0.030). DM HD pts with a Crp Ͼ 5000 ng/ml had an increased incidence (74, 43%) of TE which approached significance (pϭ0.065).Conclusions: 1.Choice of medcl does not appear to be related to history of prior TE. BB or AAD were used no more frequently in HD pts at higher risk for subsequent TE (DM, prior TE) than those at least risk (70, 64%, pϭ0.724) 2. Attainment of BP target was suboptimal and not related to presence or absence of prior TE The aim of the study is to evaluate plasma total testosterone and androstenedione levels in middle age essential hypertensive men.We investigated 215 medication-free essential hypertensive (DBP Ͼ 95 mmHg) males and 210 healty normotensive (DBP Ͻ 90 mmHg) males. All of them were 40-59 year old without any previous reported sexual dysfunction, non diabetic, non obese (BMI Ͻ 28 Kg/m2), non smoker and not taking any drug from at least 4 weeks. Venous blood samples were obtained from all subjects between 08.00 and 09.00 h and testosterone and androstenedione were evaluated by radioimmunoassay.The main results are shown in the table. In hypertensive patients plasma testosterone levels were significantly and inversely correlated with BP (systolic rϭ -0.51, pϽ 0.01; diastolic rϭ -0.24, pϽ 0.05).In conclusion middle age essential hypertensive men have a significant reduction in serum total testosterone and no change in its immediate precursor androstenedione, when compared with age-matched normotensive controls. These data suggest a relationship between hypertension and impaired testosterone metabolism in men.Key Words: Testosterone, Hypertensive Men, Androstenedione P-289 DIMINISHED EFFICACY OF EACH ADDITIONAL ANTIHYPERTENSIVE AGENT ADMINISTERED TO PATI...