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Improvement of kidney function when using combination of amlodipine/benazepril as compared with benazepril/hydrochlorothiazide (hctz) in elderly hypertensive patients (ACCOMPLISH trial). ACCOMPLISH = Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension trial).
Source publication
Hypertension is common in people aged 65 and older. African Americans and women have a higher prevalence of hypertension than white individuals, and in those aged 70 and older, the hypertension was more poorly controlled than in those aged 60–69. The number of trials available in the elderly population compared with the general population are limit...
Context in source publication
Context 1
... it appears that use of a blocker of the renin-angiotensin sys- tem may provide greater benefit on CV and renal risk reduc- tion than use of a diuretic based on data from the Avoiding Cardiovascular Events through Combination Therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial, a large outcome trial of 11,506 people with a mean age of 68 years. Although there are very few data on kidney dis- ease in the elderly population, ACCOMPLISH trial (51) did provide some evidence worthy of being tested in a prospect- ive trial, that is, that a calcium antagonist/ACE-I combin- ation led to fewer people going on dialysis than a diuretic/ ACE-I combination; an effect that could not be explained by differences in BP (Figure 4). It must be noted that those older than 70 years tend to drink small amounts of fluid and hence, this makes them more vulnerable to decline in kidney func- tion by renin-angiotensin-aldosterone system blockade; thus, it is recommended that they increase their fluid intake to prevent dehydration. ...
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Arterial stiffness is said to be a novel predictor of cardiovascular events. This study investigated the correlation between arterial stiffness parameters and the estimated cardiovascular disease risk (RISK) in a Polish cohort of patients divided by age, sex, and body-mass index (BMI). The cross-sectional study enrolled 295 patients who met the inc...
Citations
... Additionally, most CVDs can be treated via medical interventions to prevent death and improve the quality of life of CVD patients. Literature is replete with several medical interventions to manage CVD risk factors, including standard-of-care medications such as antihypertensives, hypolipidemic drugs, etc. [10][11][12][13][14][15][16][17]. ...
... (Kolaviron or Garcinia kola) and Lipoprotein 13 (Kolaviron or Garcinia kola) and Ischemia 14 (Kolaviron or Garcinia kola) and Ischemia 15 (Kolaviron or Garcinia kola) and Angiotensin 16 (Kolaviron or Garcinia kola) and Nitric oxide 17 (Kolaviron or Garcinia kola) and (Nitric oxide and cardiovascular) 18 (Kolaviron or Garcinia kola) and (Nitric oxide and hypertension) 19 (Kolaviron or Garcinia kola) and Lipid lowering 20 (Kolaviron or Garcinia kola) and Vasodilation 21 ...
While the cardiovascular effects of Kolaviron (KV) and Garcinia kola (GK) are documented in the literature, a thorough search through literature revealed a fragmentation of information on the effect of KV and GK on cardiovascular diseases (CVDs). This systematic review aims to evaluate and summarize preclinical or clinical evidence on the effect of KV and GK on CVDs. Using the PRISMA guidelines, a systematic literature search was conducted in five medical databases (PubMed, Cochrane, EMBASE, CINAHL, and Web of Science). Inclusion criteria included both in vivo and in vitro studies related to CVDs. Eligible studies included those in which specific clinical parameters, CVD biomarkers, or voltage-gated channel effects were reported. The quality of the included studies was assessed using a modified Collaborative Approach to Meta-Analysis and Review of Animal Data from the Experimental Studies (CAMARADE) checklist. A total of 22 studies were included in this systematic review. The median and mean values of the included studies' quality scores were 6 and 5.864 ± 0.296, respectively. The results from the quality assessment of included studies validate their suitability, usefulness, and fit. Based on this systematic review, the effect of KV and GK on CVDs can be divided into eight emerging trends: (1) Anti-hypertensive/Blood pressure lowering effect; (2) Lipid profile improvement effect (3) Anti-atherosclerotic effect; (4) Anti-thrombotic effect; (5) Cardioprotection; (6) Vasodilatory effect; (7) Antioxidant effects; and (8) Genetic expression and therapeutic target for cardiovascular dysfunction. From this systematic review, it can be concluded that KV is helpful in managing CVD risk factors such as hypertension and high lipids/cholesterol. Several included studies in this review demonstrated the antihypertensive, lipid improvement, antioxidant, and signaling pathway modulation effects of KV. This potentially makes KV a good therapeutic target for the management of CVDs.
... Salt restriction is the most reliable and obvious approach to mitigate the increased salt sensitivity in older persons with hypertension. In addition, guidelines suggest that diuretics are the most effective antihypertensive drugs for older adults (40). ...
Background
Age-related alterations in renal sodium handling affect blood pressure (BP). We aimed to clarify whether the pressure-natriuresis response changes with age, leading to BP elevation.
Methods
A total of 4,859 participants with normal renal function from the Korean Genome and Epidemiology Study (KoGES) and 235 patients with non-diabetic chronic kidney disease (CKD) from the ESPECIAL trial were included and divided into the younger and older groups. In ESPECIAL, participants took olmesartan from weeks 0 to 16 and were educated about a low-salt diet (LSD) from weeks 8 to 16.
Results
In both studies, older participants showed lower estimated glomerular filtration rate (eGFR) and urine concentration index and higher albuminuria. In KoGES, BP was higher and urine sodium was lower in older participants. In ESPECIAL, diastolic BP at 0 week was lower in older participants. Olmesartan reduced BP in both groups, whereas LSD decreased systolic BP only in older participants. Urine sodium increased in younger participants but decreased in older participants after olmesartan use. In KoGES, urine sodium was correlated with BP in both groups after adjusting for age, sex, and eGFR; however, the correlation coefficient was lower in older participants. In ESPECIAL, only younger participants showed a significant positive association between systolic BP and urine sodium in multiple regression analysis.
Conclusions
The pressure-natriuresis response was diminished in older participants with or without CKD.
... Menurut Raymond dan George pengobatan dan pengelolaan Hipertensi di bagi menjadi dua secara farmakologis dan non farmakologis, pengobatan secara non farmakolohis adalah dengan perubahan gaya hidup penderita Hipertensi meliputi penghentian merokok, penurunan kadar stres, mengurangi asupan natrium, dan alkohol dan peningkatan aktivitas fisik ( Oliva R V, 2017) . Olah raga untuk pengendalian hipertensi salah satunya adalah senam Hipertensi yang merupakan suatu aktivitas fisik yang dapat memacu jantung dan peredaran darah serta pernafasan yang dilakukan dalam jangka waktu yang cukup lama sehingga menghasilkan perbaikan dan manfaat pada tubuh (Suroto, 2014). ...
Hipertensi merupakan peningkatan tekanan darah pada sistolik dan diastolik secara hilang timbul atau menetap. Hipertensi menimbulkan angka morbiditas (kesakitan) dan mortalitas (kematian) yang tinggi. Penyakit hipertensi menjadi penyebab kematian 7,1 juta orang di seluruh dunia, yaitu 13% dari total kematian, prevalensinya hampir sama besar baik dinegara berkembang maupun negara maju. Hipertensi sangat erat hubungannya dengan faktor gaya hidup dan pola makan. Penderita Hipertensi di Kelurahan Baloi Permai menduduki peringkat 1 angka kejadian tertinggi terbukti dengan jumlah kunjungan selama 3 bulan terakhir pada bulan Agustus 2021 sampai Oktober 2021 tercatat sebanyak 905 orang berdasarkan jenis kelamin sebanyak 42,50% perempuan dan laki-laki sebanyak 47,50% hal ini sangat dipengaruhi dengan banyaknya masyarakat yang masih merokok yaitu 63,35%, dan dari data tersebut didapatkan hanya sebanyak 13,35% masyarakat dengan penderita yang melakukan kunjungan rutin ke fasilitas kesehatan terdekat. Tujuan penelitian ini untuk meningkatkan pengetahuan tentang hipertensi dan pencegahan Hipertensi dengan Senam Sehat Hipertensi. Metode yang digunakan penyuluhan dengan ceramah, diskusi, tanya jawab dan simulasi. Adapun hasilnya dari 24 peserta lansia di Kampung Air RW 11 yang mengikuti penyuluhan didapatkan nilai pre-test sebesar 58% dan nilai post-test 83% di mana terjadi peningkatan pengetahuan sebelum diberikan penyuluhan dibandingkan dengan setelah diberikan penyuluhan yaitu sebanyak 25%. Diharapkan masyarakat dapat memahami dan mengerti bagaimana cara pencegahan hipertensi terutama dengan pola hidup sehat dan kader posyandu juga dapat berperan aktif dalam upaya pencegahan terjadinya hipertensi pada masyarakat sekitar.
... Arterial hypertension is the most frequent chronic disease in the elderly, with more than 70% of both men and women over the age of 65 suffering from this condition [30]. Age-induced hypertension is the result of the stiffness of the conducting arteries, mainly the aorta [31], due to structural alterations of the vascular walls that include increase in collagen, loss of elastin and calcification and derangement of the fibres [32]. Another factor that contributes to the development of age-induced hypertension is endothelial dysfunction, which is a condition associated with an imbalance in the production of vasodilating agents, such as nitric oxide (NO), and vasoconstrictor agents such as endothelin-1 (ET-1) by the vascular endothelium that results in impaired vasodilation [33]. ...
Olive-derived products, such as virgin olive oil (EVOO) and/or olive leaf extracts (OLE), exert anti-inflammatory, insulin-sensitizing and antihypertensive properties and may be useful for stabilizing omega 3 fatty acids (n-3 PUFA) due to their high content in antioxidant compounds. In this study, the addition of OLE 4:0.15 (w/w) to a mixture of algae oil (AO) rich in n-3 PUFA and EVOO (25:75, w/w) prevents peroxides formation after 12 months of storage at 30 °C. Furthermore, the treatment with the oil mixture (2.5 mL/Kg) and OLE (100 mg/Kg) for 24 month old Wistar rats in 21 days improved the lipid profile, increased the HOMA-IR and decreased the serum levels of miRNAs 21 and 146a. Treatment with this new nutraceutical also prevented age-induced insulin resistance in the liver, gastrocnemius and visceral adipose tissue by decreasing the mRNA levels of inflammatory and oxidative stress markers. Oil mixture + OLE also attenuated the age-induced alterations in vascular function and prevented muscle loss by decreasing the expression of sarcopenia-related markers. In conclusion, treatment with a new nutraceutical based on a mixture of EVOO, AO and OLE is a useful strategy for improving the stability of n-3 PUFA in the final product and to attenuate the cardiometabolic and muscular disorders associated with aging.
... We also note that nearly 50% of older participants reported taking anti-hypertensive medications. Although this percentage might seem high and might seem to necessitate a caution, it is in fact entirely representative of the general population [78]. Thus, once again, there was nothing unusual about our participants. ...
Recently, some authors have suggested that age-related impairments in social-cognitive abilities-emotion recognition (ER) and theory of mind (ToM)-may be explained in terms of reduced motivation and effort mobilization in older adults. We examined performance on ER and ToM tasks, as well as corresponding control tasks, experimentally manipulating self-involvement. Sixty-one older adults and 57 young adults were randomly assigned to either a High or Low self-involvement condition. In the first condition, self-involvement was raised by telling participants were told that good task performance was associated with a number of positive, personally relevant social outcomes. Motivation was measured with both subjective (self-report questionnaire) and objective (systolic blood pressure reactivity-SBP-R) indices. Results showed that the self-involvement manipulation did not increase self-reported motivation, SBP-R, or task performance. Further correlation analyses focusing on individual differences in motivation did not reveal any association with performance, in either young or older adults. Notably, we found age-related decline in both ER and ToM, despite older adults having higher motivation than young adults. Overall, the present results were not consistent with previous claims that motivation affects older adults' social-cognitive performance, opening the route to potential alternative explanations.
... Thus, hypertension as a health-related condition is referred to as high blood pressure that can lead to severe-to-profound complications and increased risk of coronary artery diseases, cardiovascular diseases, atherosclerosis and dementia [23]. This high blood pressure (Bp) has been observed affecting 25% of the world's population, and it is the largest single contributor to global mortality [24]. It has also been found to be a significant economic burden to public healthcare providers in most countries of the world, even with improved pharmacological and counselling treatment. ...
... Hypertension is an age-dependent health-related condition, as it is common in people aged 65 and older, and a clinical diagnosis is established by demonstrating a systolic Bp of greater than or equal to 140 mmHg and/or diastolic Bp of greater than or equal to 90 mmHg on at least three different Bp measurements [24,25]. Hypertension can be confirmed with a repeated blood pressure checkups, based on the manifestation of consistently high blood pressure with a force of the blood flowing against the walls of the blood vessels. ...
... While this goal may be possible for some older individuals, it is not for all, particularly for those with poor vascular compliance, which the guideline did not address since such patients were not in SPRINT. Numerous trials assessed BP lowering in older people with predominant or isolated systolic hypertension [14]. Many people in these trials were unable to tolerate BP levels < 140 mmHg, let alone < 130 mmHg. ...
... Note that there is concern that the guidelines may increase the risk of overtreatment, particularly, in the older adults over the age of 75 who are vulnerable to dehydration, hypotension, and overall worst outcomes. This harm was overlooked by the guidelines which were heavily based on the SPRINT results and ignoring earlier large trials in this subset like the Systolic Hypertension in the Elderly Program and others [14]. ...
Purpose of Review
To provide an overview of the different guidelines for hypertension management from around the world.
Recent Findings
The guidelines discussed include those from the United States (US), Europe, Canada, and Latin America. All guidelines except the US define hypertension as > 140/90 mmHg, and the US defines it as > 130/80 mmHg. In general, all guidelines except those from the US emphasize lifestyle modification as the cornerstone of initial therapy given blood pressure levels < 140/90 mmHg. The US emphasizes lifestyle modification at all BP levels starting at 130/80 mmHg. Additionally, all guidelines emphasize the need to assess cardiovascular risk with the Canadian guidelines indicating that a high cardiovascular risk person should have a goal of < 130/80 mmHg. All agree on the proper method of blood pressure measurement techniques and importance of home blood pressure. All support use combination therapy with the European guideline emphasizing initial therapy should be a combination pill. All guidelines stress the importance of patient adherence to maintain blood pressure control.
Summary
All guidelines emphasize lifestyle modification, need for home blood pressure measurement, as well as use of proper techniques to measure blood pressure. The fundamental difference between US and all other guidelines is the definition of hypertension, > 130/80 mmHg in US and > 140/90 mmHg in the rest of the world.
... Management of hypertension in the elderly is same as a management in an adult patient, which is preceded by a non-medical therapy that is lifestyle modification, combined with the management of antihypertension drug therapy [7,8,11,12]. Hypertensive patients are encouraged to reduce salt/sodium and alcohol consumption [7,12]. ...
... Management of hypertension in the elderly is same as a management in an adult patient, which is preceded by a non-medical therapy that is lifestyle modification, combined with the management of antihypertension drug therapy [7,8,11,12]. Hypertensive patients are encouraged to reduce salt/sodium and alcohol consumption [7,12]. Smoking as a risk factor for cardiovascular disease also needs to be stopped. ...
... Smoking as a risk factor for cardiovascular disease also needs to be stopped. Patients also need to reduce stress because it can also trigger a rise in blood pressure [12]. Other examples of lifestyle modification are weight loss and regular physical activity [7,8,12]. ...
... Its prevalence continues to increase with age. Consequently, in subjects over 70 years, the prevalence of hypertension reaches 60-70% [3]. Despite the effectiveness of modern antihypertensive drugs, approximately 70% of hypertensive patients fail to achieve the therapeutic goal of blood pressure <140/90 mmHg with monotherapy; and even less patients will reach the new therapeutic goals <130/80 mmHg recommended in the 2017 ACC/AHA/AAPA/ABC/ACPM/ AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults [4], using only one antihypertensive drug. ...
Hypertension is a major preventable risk factor for atherosclerosis and ischemic heart disease. Although modern and effective antihypertensive drugs are available, most patients remain with a suboptimal blood pressure control. Most hypertensive patients will need a combination of antihypertensive agents to achieve the therapeutic goals – recent guidelines recommend initiating treatment with two drugs in those patients with a systolic blood pressure >20 mmHg and/or a diastolic blood pressure >10 mmHg above the goals, and in those patients with high cardiovascular risk. In addition, approximately 25% of patients will require three antihypertensive agents to achieve the therapeutic targets. In this review, we analyse the latest information available regarding the treatment of hypertension with combination therapy.
... A self-designed questionnaire was used as a data collection tool, which was designed similar to that used in the extensive literature review of similar studies. 38,42,43 The questionnaire included: 1) patient's demographics such as age, sex, marital status, education, insurance, annual household income, and number of family members; 2) clinical characteristics such as health status, comorbidities, sickness status, and blood pressure control status; 3) patient's medication adherence; and 4) health services used such as outpatient visits, hospitalization visits, and emergency visits. The data were collected through a face-to-face interview, which lasted for an average of 15-20 minutes. ...
... In addition, blood pressure control is considered as a binary variable; thus, patients with a systolic blood pressure ,140 mmHg and/or a diastolic blood pressure ,90 mmHg are regarded as having control over their blood. 42,43 Regular clinical check was a binary variable, patients who were considered having regular clinical check should have at least once clinical check within 3 months, otherwise they were considered to have no regular clinical check. Regular blood pressure check was a dichotomous variable, patients with regular blood pressure check should measure their blood pressure at least once within a week, if not, they were considered to have no regular blood pressure check. ...
Purpose
The analysis of factors affecting the nonadherence to antihypertensive medications is important in the control of blood pressure among patients with hypertension. The purpose of this study was to assess the relationship between factors and medication adherence in Xinjiang community-managed patients with hypertension based on the principal component analysis.
Patients and methods
A total of 1,916 community-managed patients with hypertension, selected randomly through a multi-stage sampling, participated in the survey. Self-designed questionnaires were used to classify the participants as either adherent or nonadherent to their medication regimen. A principal component analysis was used in order to eliminate the correlation between factors. Factors related to nonadherence were analyzed by using a χ²-test and a binary logistic regression model.
Results
This study extracted nine common factors, with a cumulative variance contribution rate of 63.6%. Further analysis revealed that the following variables were significantly related to nonadherence: severity of disease, community management, diabetes, and taking traditional medications.
Conclusion
Community management plays an important role in improving the patients’ medication-taking behavior. Regular medication regimen instruction and better community management services through community-level have the potential to reduce nonadherence. Mild hypertensive patients should be monitored by community health care providers.
