Aggressive systolic blood pressure control in older subjects: benefits and risks.

Abstract:

:Systolic hypertension, especially isolated systolic hypertension (ISH) is very common in older subjects aged ≥ 65 years and is a major risk factor for cardiovascular disease (CVD), strokes, heart failure (HF) and chronic kidney disease (CKD). It is also, directly and linearly related with these complications irrespective of sex, or ethnicity, but it is worse with the advancement of age. Effective control of systolic blood pressure (SBP), is associated with significant reduction in the incidence of these complications. Currently, there is a debate about the optimal SBP control in view of the Systolic Blood Pressure Intervention Trial (SPRINT) showing beneficial cardiovascular (CV) effects of intensive SBP of < 120 mmHg in older patients. Also, the recently released blood pressure (BP) guidelines by the American College of Cardiology, the American Heart Association and the American Society of Hypertension (ACC/AHA/ASH) recommend a SBP reduction of < 130 mmHg. These SBP treatment recommendations are in contrast with the current (JNC VIII) committee of BP treatment guidelines, which recommend a SBP reduction < 150 mmHg for the same age of patients. All these different recommendations have created a debate regarding the optimal treatment targets for the systolic hypertension of the elderly patients. To gain more information a focused Medline search was conducted from 2010 to 2017 using the terms, systolic blood pressure, aggressive control, older subjects, treatment guidelines, and 37 pertinent papers were retrieved. The findings from these studies suggest a SBP reduction of < 140 mm Hg for persons aged ≥ 60 years, with an attempt for SBP reduction to ≤130 mm Hg in healthier subjects and hose with CVD, DM, and CKD. Care should be taken not to further reduce the SBP in older subjects if their DBP is ≤60 mmHg for the fear of J-curve effect.

journal_name

Postgrad Med

journal_title

Postgraduate medicine

authors

Chrysant SG

doi

10.1080/00325481.2018.1433434

subject

Has Abstract

pub_date

2018-03-01 00:00:00

pages

159-165

issue

2

eissn

0032-5481

issn

1941-9260

journal_volume

130

pub_type

杂志文章,评审
  • Site-specific techniques of joint injection. Useful additions to your treatment repertoire.

    abstract::Joint and soft-tissue aspiration and injection procedures are relatively easy to master once the physician has acquired an understanding of the techniques and subtleties of performing these procedures at certain sites. These techniques can be used to diagnose and treat many painful joint and soft-tissue conditions and...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.3810/pgm.2001.03.879

    authors: Rifat SF,Moeller JL

    更新日期:2001-03-01 00:00:00

  • Asthma and COPD: definitions, epidemiology, and treatment guidelines.

    abstract::Asthma and chronic obstructive pulmonary disease (COPD) are disorders that affect millions of people in the United States and other countries in the world. Asthma is a chronic inflammatory disease of the airways that has cellular and molecular pathways. Affected patients have recurrent episodes of wheezing, dyspnea, c...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.3810/pgm.12.2005.suppl44.232

    authors: Berger WE,Cline DC

    更新日期:2005-12-01 00:00:00

  • Coronary artery disease in Hispanic Americans. How does ethnic background affect risk factors and mortality rates?

    abstract::A concerted national effort has reduced cardiovascular mortality rates in the general US population. Unfortunately, not all ethnic groups have benefited equally from these improvements in our national health. The author presents insights into social and clinical factors that affect cardiovascular disease among Hispani...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1992.11701252

    authors: Caralis PV

    更新日期:1992-03-01 00:00:00

  • Significance of serrated epithelial change in inflammatory bowel disease.

    abstract:OBJECTIVES:The clinical significance of hyperplastic polyp-like histologic changes in random biopsy samples ('serrated epithelial change' or SEC) from patients with inflammatory bowel disease (IBD) remains uncertain, with some studies suggesting an increased risk of dysplasia and even carcinoma. Controlled studies are ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.2020.1802138

    authors: Batts KP,Atwaibi M,Weinberg DI,McCabe RP

    更新日期:2021-01-01 00:00:00

  • Turkish doctors' cohort: healthy despite low screening.

    abstract:OBJECTIVES:We aimed to determine the prevalence of chronic diseases and unhealthy lifestyle behaviors of Turkish doctors as compared with the general population and the frequency of compliance with preventive clinical practices among doctors. METHODS:This was an observational, prospective cohort study that enrolled gr...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.2017.1272399

    authors: Unal S,Tanriover MD,Ascioglu S,Demirkazik A,Ertenli I,Eskioglu E,Guler K,Kiraz S,Ozbakkaloglu M,Ozer B,Tukek T,Akyar S,Erdem Y

    更新日期:2017-04-01 00:00:00

  • Congestive heart failure.

    abstract::Preview Congestive heart failure (CHF) is a common and serious problem, and its diagnosis and treatment should not be the exclusive province of the cardiologist. Primary care physicians can very adequately manage most cases in a cost-effective manner. In this article, Dr Seager gives guidelines for a standard approach...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1995.11946074

    authors: Seager LH

    更新日期:1995-11-01 00:00:00

  • Hormone abnormalities in patients with severe and chronic pain who fail standard treatments.

    abstract::Some patients with severe and chronic pain fail to obtain adequate pain relief with standard pharmacologic treatment agents, including low to moderate dosages of opioids. Understandably, physicians might not believe patients who claim that a standard opioid dosage is an ineffective treatment. These patients may be sev...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.2014.996110

    authors: Tennant F

    更新日期:2015-01-01 00:00:00

  • Skin signs of systemic disease. When the problem is more than skin-deep.

    abstract::The cutaneous manifestations of systemic diseases are diverse. In some cases, they are the first signs of an underlying disorder, such as Cowden's disease, dermatomyositis, and Lyme disease. Sister Mary Joseph's nodule (metastatic involvement of the umbilicus) is an ominous sign of internal malignant disease. Drug-ind...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:

    authors: Holmes CE,Massa MC

    更新日期:1994-12-01 00:00:00

  • Pediatric poisoning the first 30 minutes.

    abstract::Two distinct subpopulations in the pediatric age-group are particularly at risk for poisoning, and the substances likely to be ingested by each group differ. The method of critical care given here incorporates consideration of specific types of poisoning into an overall plan of general diagnostic and therapeutic measu...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1982.11716152

    authors: Driggers DA

    更新日期:1982-08-01 00:00:00

  • Evaluating peripheral arterial occlusive disease.

    abstract::The clinical history and physical examination remain the most important factors in determining the presence, anatomic location, and physiologic extent of arterial occlusive disease and the need for operation. The physician should refrain from ordering arteriography to confirm the diagnosis of arterial disease unless o...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1976.11714271

    authors: Barnes RW

    更新日期:1976-02-01 00:00:00

  • Gastroesophageal reflux.

    abstract::Preview Although heartburn is the most common symptom of gastroesophageal reflux, many patients with reflux have other, more obscure manifestations. Recognition of all potential signs and symptoms of reflux is important for expeditious management. This article focuses on these atypical presentations and discusses how ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1996.11946110

    authors: Barr LL

    更新日期:1996-04-01 00:00:00

  • A practical approach to dizziness. Questions to bring vertigo and other causes into focus.

    abstract::Evaluation of a patient presenting with dizziness begins with and largely depends on the patient's history. The diagnosis often can be accurately determined in a primary care setting when a stepwise algorithmic approach is used. The first step is getting a detailed account of precisely what the patient means by "dizzi...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:

    authors: Ruckenstein MJ

    更新日期:1995-03-01 00:00:00

  • Acute intermittent porphyria. More than just abdominal pain.

    abstract::Acute intermittent porphyria is an unusual syndrome that may be very difficult to differentiate from acute intraabdominal processes. Diagnosis requires the documentation of increased urinary porphobilinogen. Failure to perform appropriate tests early in the attack may necessitate diagnostic laparotomy to rule out intr...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.1080/00325481.1989.11704454

    authors: Holman JR,Green JB

    更新日期:1989-10-01 00:00:00

  • Health care provider management of patients with type 2 diabetes mellitus: analysis of trends in attitudes and practices.

    abstract:OBJECTIVE:To identify attitudes and practices of endocrinologists (ENDOs), family practitioners (FPs), internists (IMs), primary care nurse practitioners (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 diabetes m...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.3810/pgm.2014.05.2764

    authors: Williamson C,Glauser TA,Burton BS,Schneider D,Dubois AM,Patel D

    更新日期:2014-05-01 00:00:00

  • New onset diabetes mellitus induced by statins: current evidence.

    abstract::The hydroxyl-methyl-glutaryl-coenzyme-A (HMG-CoA) reductase inhibitors of statin action are very effective and safe drugs, and they are widely used for the treatment of hyperlipidemia and the prevention of primary and secondary cardiovascular diseases (CVDs). However, recent meta-analyses of previous studies done with...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.1080/00325481.2017.1292107

    authors: Chrysant SG

    更新日期:2017-05-01 00:00:00

  • Functional assessment in older patients.

    abstract::Preview Practical assessment of the functional and support factors affecting quality of life in older patients should be an integral part of medical management. This approach allows physicians to focus on remediable problems that compromise patients' daily functioning and may hinder them from living independently. In ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1996.11946120

    authors: Paist SS 3rd,Jafri A

    更新日期:1996-05-01 00:00:00

  • Follow-up after therapy for prostate cancer. Treating the problems and caring for the man.

    abstract::With prostate cancer being diagnosed and treated in more than 300,000 men each year, the pool of long-term survivors is dramatically increasing. Because these patients are usually elderly, they are often receiving follow-up care for unrelated problems in a primary care setting. This offers the physician an excellent o...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.3810/pgm.1996.09.73

    authors: Freedman A,Hahn G,Love N

    更新日期:1996-09-01 00:00:00

  • Viral hepatitis. 2. Prevention and control.

    abstract::Good personal hygiene is one of the most important measures for control of hepatitis infection. Hepatitis is transmitted by close contact with an infected person or nonhuman primate, exposure to infected food or water, transfusion of infected blood, dialysis, or contact with hepatitis-containing laboratory specimens. ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1980.11715590

    authors: Bryan JA

    更新日期:1980-11-01 00:00:00

  • Evaluation of postoperative changes in mental status.

    abstract::When confronted with a patient with an alteration in mental status following surgery, the physician must consider both organic and psychosocial causes and their synergistic interactions. A careful medical assessment will rule out metabolic disorders, sepsis, cardiopulmonary complications, and adverse drug effects. A m...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1980.11715409

    authors: Thompson TL 2nd,Feinberg LE

    更新日期:1980-03-01 00:00:00

  • Gastrointestinal foreign bodies. When to remove them, when to watch and wait.

    abstract::By being aware of which patients are at high risk for ingestion or insertion of foreign bodies, physicians can be on the lookout for objects in the gastrointestinal tract and ready to institute initial care. Esophageal foreign bodies and other objects that increase the chance of perforation or obstruction may require ...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1992.11701481

    authors: Clarkston WK

    更新日期:1992-10-01 00:00:00

  • The effect of intravenous insulin, apheresis and oral lipid-lowering agents on non-fasting hypertriglyceridemia and associated pancreatitis.

    abstract:OBJECTIVES:There is evidence that increasing severity of hypertriglyceridemia increases the risk of acute pancreatitis. There is a debate about superiority of treatment methods and previous works have specifically called for direct comparison between IV insulin and apheresis techniques. Identify patient characteristics...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.2018.1470439

    authors: Frankova D,Olson KM,Whyms BJ,Guevara Hernandez MA,Franko J

    更新日期:2018-06-01 00:00:00

  • Acute poisoning: management protocol.

    abstract::Management of the acutely poisoned patient should start with decontamination of the skin and irrigation of the eyes, if necessary, and assessment of cardiorespiratory status, neurologic status, and pupils and eye movement. If a definable toxic syndrome is present, the specific "antidote" should be given. If no such sy...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1982.11716063

    authors: Saxena K,Kingston R

    更新日期:1982-05-01 00:00:00

  • When epilepsy masquerades as heart disease. Awareness is key to avoiding misdiagnosis.

    abstract::Autonomic neural impulses that accompany discharges during a seizure can cause a variety of cardiac manifestations, including cardiac arrhythmias, sudden death, anginal chest pain, neurogenic pulmonary edema, and symptoms of pheochromocytoma. Either generalized or focal seizures may generate such signs and symptoms. A...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1990.11716430

    authors: Kothari SS

    更新日期:1990-11-01 00:00:00

  • Bacillus coagulans significantly improved abdominal pain and bloating in patients with IBS.

    abstract:BACKGROUND:Symptoms of irritable bowel syndrome (IBS) can have a profound impact on emotional health and quality of life, and current treatments are sometimes unsatisfactory for patients facing this lifelong disease. Probiotics, which can normalize gastrointestinal microflora, may alleviate symptoms of IBS. OBJECTIVE:...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.3810/pgm.2009.03.1984

    authors: Hun L

    更新日期:2009-03-01 00:00:00

  • Severe gastroesophageal reflux disease. Medical and surgical options for long-term care.

    abstract::Severe gastroesophageal reflux disease is usually a chronic problem with periods of relapse, but effective medical and surgical therapies are available. Two recently introduced agents, omeprazole (Prilosec) and cisapride (Propulsid), represent advances in medical therapy; the safety of long-term, continuous omeprazole...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:

    authors: Marshall JB

    更新日期:1995-05-01 00:00:00

  • Primary Pseudomonas maltophilia infection of the lung.

    abstract::To our knowledge, this is the first reported case of primary Pseudomonas maltophilia pneumonia. Presenting symptoms were fever and chills of two days' duration and a density in the right upper lobe. Sputum culture showed normal flora, and multiple blood cultures were negative. Antibiotic therapy initially with penicil...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1979.11715067

    authors: Sarkar TK,Gilardi G,Aguam AS,Josephson J,Leventhal GL

    更新日期:1979-02-01 00:00:00

  • Gram-negative bacteremia. Two cases in adults with chronic otitis media.

    abstract::Chronic otitis media was the cause of septicemia in two hospitalized men. The organisms involved, K pneumoniae and B fragilis, are not usually associated with primary infections of the middle ear and would not have been traced to this site had proper cultures not been performed. In adults, the true incidence of bacter...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:

    authors: Mowjood MM,Arroyo JC

    更新日期:1979-09-01 00:00:00

  • Advantages of extended-release metformin in patients with type 2 diabetes mellitus.

    abstract::Metformin is a first-line pharmacological treatment for patients with type 2 diabetes mellitus because of its favorable overall profile, including its glucose-lowering ability, weight-neutral effects, and low risk of hypoglycemia; however, gastrointestinal (GI) intolerance may limit use in some patients. Extended-rele...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章,评审

    doi:10.3810/pgm.2011.01.2241

    authors: Jabbour S,Ziring B

    更新日期:2011-01-01 00:00:00

  • Demystifying hypoglycemia. When is it real and how can you tell?

    abstract::Contrary to popular belief, hypoglycemia is an infrequently encountered condition and its presence is questionable until confirmed by appropriate tests. In ambulatory patients, blood glucose levels obtained during intake of a normal diet are more reliable than those obtained during a glucose tolerance test. If the blo...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1987.11700028

    authors: McFarland KF,Baker C,Ferguson SD

    更新日期:1987-11-01 00:00:00

  • Treatment of osteoporosis. What is the role of calcium?

    abstract::On the basis of currently available information, the following recommendations can be made for treating osteoporosis. Women with no contraindications should maintain a total calcium intake of 1,000 mg daily before menopause and 1,500 mg daily after menopause. Calcium supplementation should be considered adjunct treatm...

    journal_title:Postgraduate medicine

    pub_type: 杂志文章

    doi:10.1080/00325481.1990.11704612

    authors: Trachtenbarg DE

    更新日期:1990-03-01 00:00:00