Isolated systolic hypertension in the elderly: Results of a statewide survey of clinical practice in New Jersey

Breckenridge, Mary B.; Kostis, John B.

doi:10.1016/0002-9343(89)90331-8

Cited by 16 publications

(4 citation statements)

References 13 publications

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“…Data from the National Disease and Therapeutic Index suggest that by 1993, the use of these latter two classes of agents had grown to more than half the market share 2,7 . This contrasts sharply with a 1985‐86 survey of New Jersey physicians in which calcium channel blockers and ACE inhibitors combined were preferred as agents for first line therapy for isolated systolic hypertension by fewer than 3% of respondents 8 . These changes are reported to be pronounced among older patients, especially in newly diagnosed hypertensives 5 …”

mentioning

confidence: 93%

Antihypertensive Medication Use Among Recruits for the Trial of Nonpharmacologic Interventions in the Elderly (TONE)

Espeland

Kumanyika

Kostis

et al. 1996

J American Geriatrics Society

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confidence: 93%

Antihypertensive Medication Use Among Recruits for the Trial of Nonpharmacologic Interventions in the Elderly (TONE)

Espeland

Kumanyika

Kostis

et al. 1996

J American Geriatrics Society

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“…Analysis of the magnitude of postural hypotension in subgroups of persons with isolated systolic hypertension (ISH) may clarify approaches to screening for postural hypotension by possibly identifying persons at higher risk. Data on the frequency of postural hypotension among persons with ISH should also serve to guide treatment of ISH at a time when increasing numbers of physicians report they are using drug therapy for this condition 6 …”

mentioning

confidence: 99%

“…Data on the frequency of postural hypotension among persons with ISH should also serve to guide treatment of ISH at a time when increasing numbers of physicians report they are using drug therapy for this condition. 6 The Systolic Hypertension in the Elderly Program (SHEP) has enrolled 4,736 persons, ages 60 and greater, with a SBP 2 160 mmHg and diastolic blood pressure (DBP) <90 mmHg7 This paper describes the baseline prevalence of postural hypotension in the SHEP cohort and factors associated with orthostatic decreases in blood pressure.…”

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confidence: 99%

Prevalence of Postural Hypotension at Baseline in the Systolic Hypertension in the Elderly Program (SHEP) Cohort

Applegate

Davis

Black

et al. 1991

J American Geriatrics Society

153

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Somewhat different persons were defined as having PH based upon the 1 minute and 3 minute standing measures of BP, and prevalence estimates of PH can vary depending on whether one or more intervals of measurement are used. Cross-sectional data analysis indicated that PH, in healthy community-dwelling older persons with ISH, may not be associated with a history of disorders or problems usually thought to be related to PH. However, prospective data are needed to determine the prognostic significance of PH, and whether one or multiple measurements carry more significance.

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“…In a state-wide survey of clinical practices concerning treatment ofISH in the elderly in New Jersey, USA, the choice of thiazide diuretics either alone or in combination with a potassium-sparing diuretic was the first-line drug for 67% of the family physicians (Breckenridge & Kostis 1989). The results of the EWPHE· and the SHEP trials confirmed the interest for low doses of diuretics.…”

Section: Drugs Used For the Treatment Of Ish In Elderly Patientsmentioning

confidence: 95%

What is the Clinical Relevance of Isolated Systolic Hypertension?

Emeriau

1992

Drugs & Aging

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During normal aging, systolic blood pressure (SBP) rises and a large proportion of elderly people develop isolated systolic hypertension (ISH). ISH was previously considered to be a normal mechanism that was able to preserve brain, coronary and kidney blood flow despite the development of atherosclerosis. The European Working Party on Hypertension in the Elderly (EWPHE) trial (Amery et aL 1985;Staessen et aL 1989) and the Systolic Hypertension Elderly Program (SHEP Cooperative Research Group 1991) have modified the ideas concerning the epidemiology of and the therapeutic possibilities for treating ISH in the elderly. PrevalenceIn most developed countries advancing age is associated with a progressive and continuous rise in SBP to levels of 150mm Hg by the age of 70 to 80 years. Diastolic blood pressure (DBP) generally does not increase after middle age (50 to 60 years) and in fact may decrease gradually after the age of 60 years. The age-related increase in SBP is accompanied by an increasing prevalence of ISH, which is generally defined as SBP ~ 160mm Hg with a DBP < 95mm Hg in some studies, and < 90mm Hg in others (Dustan 1989). The epidemiology of hypertension in the elderly is reviewed later in this issue (Morgenstern & Byyny 1992).After middle age the prevalence of ISH rises progressively in both sexes becoming the most common form of hypertension in the population over the age of 60 years (Saltzberg et aL 1988). In North America the prevalence of ISH was determined in a representative sample of the entire population of noninstitutionalised adults by the National Health Examination Survey using the criteria ofSBP > 160mm Hg and DBP < 95mm Hg.Blood pressure was taken as the average of 3 sitting readings measured at 25-minute intervals during a single visit. The prevalence progressively increased with age regardless of sex or race. In most age groups, a higher incidence was found for Blacks compared with Whites, and women compared with men; for example the incidence in both women and men between the ages of 70 to 79 years was 14%, and for those 80 years and over was 21 % and 17%, respectively (SHEP Cooperative Research Group 1991).Similar findings have been observed in Europe. In the southwest of France, the prevalence of ISH increased from 12.1 % in people between the ages of 65 to 69 years to 19.1 % in those between the ages of 75 to 90 years (Emeriau et aL 1988). In a Belgian study, SBP and DBP were measured 5 times consecutively on each of 2 separate home visits at intervals ~ 1 day; the prevalence of ISH (DBP < 95mm Hg) decreased from 14 to 9.5% between the first and second visits (Staessen et aL 1990).Two points must be discussed. First, should the cut-off point for DBP be < 95 or < 90mm Hg? If the cut-off point is < 90mm Hg the prevalence is 8%, which is considerably lower than that found

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Isolated systolic hypertension in the elderly: Results of a statewide survey of clinical practice in New Jersey

Cited by 16 publications

References 13 publications

Antihypertensive Medication Use Among Recruits for the Trial of Nonpharmacologic Interventions in the Elderly (TONE)

Antihypertensive Medication Use Among Recruits for the Trial of Nonpharmacologic Interventions in the Elderly (TONE)

Prevalence of Postural Hypotension at Baseline in the Systolic Hypertension in the Elderly Program (SHEP) Cohort

What is the Clinical Relevance of Isolated Systolic Hypertension?

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