RESUMO
The decision to use diastolic blood pressure as the basis for therapeutic intervention for hypertension was based primarily on clinical trials experience. The majority of observational studies shows as great or greater risk for elevated systolic blood pressure readings. Even many of the clinical trials in which a posteriori analyses have been performed confirm a greater effect of systolic rather than diastolic blood pressure as a predictor of coronary heart disease mortality. The current practice of using diastolic blood pressure readings as the sole treatment criterion should be reexamined in light of the observational studies and clinical trials reviewed here.
Assuntos
Pressão Sanguínea , Hipertensão , Adulto , Fatores Etários , Idoso , Ensaios Clínicos como Assunto , Doença das Coronárias/etiologia , Diástole , Métodos Epidemiológicos , Feminino , História do Século XIX , História do Século XX , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertensão/etiologia , Hipertensão/história , Masculino , Pessoa de Meia-Idade , SístoleRESUMO
A retrospective study was undertaken to analyze the effects of various patient factors on therapy and its outcome in elderly hypertensive subjects. Two hundred and three male hypertensives with a mean age of 63.1 years at entry, were followed in a special hypertension clinic by nurse practitioners under physician supervision, for 2 years or more (mean 3.7 years). Good patient compliance (84%) and blood pressure (BP) reduction were achieved and these were enhanced by advancing age. Neither excessive weight, nor widespread atherosclerosis seemed to interfere with BP control. However, while diastolic BP was well controlled with antihypertensive therapy, systolic BP tended to remain higher than 160 mm Hg in many of the older and more atherosclerotic subjects. Pharmacological treatment did not prevent a gradual although modest deterioration of renal function, which was related to both age and hypertension, and represents a greater problem in black patients. Because of the limitations of such a retrospective study, its conclusions may not be extrapolated for treatment of hypertension in all the elderly.