Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial.

Rutan, Gale H.; Kuller, Lewis H.; Neaton, James D.; Wentworth, Deborah; McDonald, Robert H.; Smith, William M.

doi:10.1161/01.cir.77.3.504

Cited by 284 publications

(118 citation statements)

References 37 publications

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“…3 These data support actuarial statistics 4 -6 and classic experimental studies based on measurement of systolic pressure 7 and call into question the preoccupation of clinicians, until quite recently, with diastolic pressure exclusively in the definition and management of hypertension.…”

mentioning

confidence: 72%

Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension.

et al. 1989

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We compared dilevalol (an isomer of labetalol), 200-400 mg daily, against atenolol, 50-100 mg daily, in a double-blind, crossover, placebo-controlled trial with respect to effects on arterial distensibility (measured as pulse wave velocity [FVW]) and wave reflection (assessed from carotid pressure wave contour). Twelve patients of mean age 58 years (range 44-73 years) with essential hypertension (supine diastolic blood pressure 95-114 mm Hg) took active therapy for 12 weeks, separated by a 2-4-week placebo period. Carotid pressure waveforms were recorded noninvasively by applanation tonometry with a Millar micromanometer-tipped probe. PVW was measured between carotid and femoral arteries (aortic PWV), carotid and radial arteries (arm PVW), and femoral and pedal arteries (leg PWV). Early wave reflection was calculated from the ratio of the height of the peak of the carotid wave above its shoulder to the pulse pressure and was expressed as an augmentation index. Both drugs were equally effective in reducing brachial sphygmomanometric pressure and PWV in all three regions (active vs. placebo, p<0.001), but there was no significant difference between the two active therapies. However, the augmentation index (averaged during the treatment period) was significantly lower with dilevalol (19%) than with atenolol (28%, /;<0.01), corresponding to a greater decrease of 5-8 mm Hg in carotid systolic pressure compared with the brachial artery. Although both drugs were equally effective in reducing arterial distensibility, the vasodilating action of dilevalol gave added benefit in reducing wave reflection, presumably through its vasodilatory effect on peripheral conduit arteries. (Hypertension 1989;14:14-21)

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confidence: 72%

Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension.

et al. 1989

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“…30 In the Multiple Risk Factor Intervention Trial (MRFIT) about 40% of strokes were attributable to elevation of systolic blood pressure above 140 mm Hg. 31 A 10-year longitudinal survey demonstrated that the association between systolic blood pressure and the incidence of strokes persisted at highly advanced ages. 32 On the whole, it has been consistently demonstrated for three decades that isolated systolic hypertension is the greatest risk factor for cerebrovascular complications other than age.…”

Section: Mortalitymentioning

confidence: 99%

Cerebral complications of hypertension

Rigaud

Staessen

et al. 2000

J Hum Hypertens

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Ischaemic and degenerative brain diseases are a major health problem leading to a devastating loss of autonomy. Hypertension has been shown to carry an increased risk not only for cerebrovascular morbidity and mortality but also for cognitive impairment and dementia. Although diastolic blood pressure is considered an important risk factor, it is now clear that isolated systolic hypertension and elevated pulse pressure also play an important role in the development of brain complications. Therefore the treatment of these conditions must urgently become a widespread tool of prevention. All the randomised placebo-controlled trials completed for the last 30 years have shown a reduction in fatal and/or non-fatal strokes. In the most recent trials in isolated systolic hypertension in older patients, the benefit was even greater because of the higher risk in these populations. The new classes of drugs, in particular, calcium-channels blockers and angiotensin-

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“…2,4,[6][7][8] In addition, these studies have clearly demonstrated that SBP is an important and independent cardiovascular risk factor. 2,6,9 In patients with ISH mean arterial pressure (MAP) and vascular resistance may be normal or slightly elevated, while pulse pressure, the difference between SBP and DBP, is increased. [10][11][12] It has been shown that an increase in pulse pressure contributes considerably to the increase in cardiovascular morbidity and mortality seen at higher ages.…”

Section: Introductionmentioning

confidence: 99%

Treatment of elderly patients with isolated systolic hypertension with isosorbide dinitrate in an asymmetric dosing schedule

Starmans-Kool

Kleinjans²,

Lustermans

et al. 1998

J Hum Hypertens

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Nitrates decrease pulse pressure more than mean arterial pressure (MAP) and are advocated for the treatment of isolated systolic hypertension (ISH). Nitrates show drug tolerance during chronic treatment so an asymmetric dosing regimen may prevent loss of effect of nitrates. This study investigates the anti-hypertensive effect of isosorbide dinitrate (ISDN) given in a twice daily asymmetric dosing regimen in elderly patients with ISH.After a 6-week placebo run-in period, patients entered the double-blind study. Ten patients received placebo and 11 patients ISDN 20 mg b.i.d. for 8 weeks. This dose could be doubled once. Office systolic and diastolic blood pressures (SBP/DBP) and ambulatory BP were measured. Pulse pressure was calculated as SBP-DBP.Office pulse pressure was more reduced during ISDN

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Mortality associated with diastolic hypertension and isolated systolic hypertension among men screened for the Multiple Risk Factor Intervention Trial.

Cited by 284 publications

References 37 publications

Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension.

Arterial dilation and reduced wave reflection. Benefit of dilevalol in hypertension.

Cerebral complications of hypertension

Treatment of elderly patients with isolated systolic hypertension with isosorbide dinitrate in an asymmetric dosing schedule

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