Abstract:
BACKGROUND:There are now more than 31 million people 65 years of age or older in the United States, at least half of whom have systolic blood pressure 140 mm Hg or higher or diastolic blood pressure 90 mm Hg or higher or both. By the year 2050, 16 million Americans will be over age 85. OBJECTIVE:To review the current data and recommendations regarding treating hypertension in elderly patients. SUMMARY:Randomized clinical trials have dispelled some of the myths that surround treatment of hypertension in the elderly by showing that judicious treatment of elevated blood pressure, both systolic and diastolic, will reduce the risk of cardiovascular morbidity and mortality, with an acceptable trade-off in terms of side effects and without sacrificing quality of life. CONCLUSIONS:Because most of the trials have used a diuretic as initial therapy, it is recommended that one of these agents be prescribed in low doses if life-style modifications do not reduce blood pressure to acceptable levels, unless there is a contraindication to diuretics or an indication for another class of agents.
journal_name
Cleve Clin J Medjournal_title
Cleveland Clinic journal of medicineauthors
Gifford RW Jrdoi
10.3949/ccjm.62.1.29subject
Has Abstractpub_date
1995-01-01 00:00:00pages
29-35issue
1eissn
0891-1150issn
1939-2869journal_volume
62pub_type
杂志文章,评审abstract::Patients with alcohol use disorder (AUD) are at higher risk of pneumonia and of poor outcomes. This article reviews the etiology of pneumonia in patients with AUD, its impact on mortality and resource utilization, and its implications for treatment. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.87a.19105
更新日期:2020-07-31 00:00:00
abstract::The metabolic syndrome--the cluster of obesity, impaired fasting glucose, elevated triglycerides, low high-density lipoprotein cholesterol, and hypertension--may not be a "real" syndrome in the strict sense. It can, however, still be a useful concept if it prompts a physician to look for and treat additional risk fact...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.74.3.199
更新日期:2007-03-01 00:00:00
abstract::The threshold for testing for hepatitis C virus (HCV) should be low for persons with any risk factor for HCV infection. Current practice calls for first screening for antibodies to HCV and then testing for HCV RNA in those in whom antibodies are detected. Viral testing can distinguish between active and resolved HCV i...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.70.suppl_4.s7
更新日期:2003-09-01 00:00:00
abstract::Obstructive sleep apnea (OSA) is a serious condition associated with impaired quality of life, depression, drowsy driving and motor vehicle accidents, metabolic disease, and cognitive decline. The mechanisms accounting for OSA and metabolic disease include hypoxia, sleep fragmentation, and systemic inflammation. OSA a...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.86.s1.04
更新日期:2019-09-01 00:00:00
abstract::Too often, physicians, patients, and families make end-of-life care decisions despite poor physician-patient communication and misunderstanding by the patient and family about the effectiveness of cardiopulmonary resuscitation. We describe an approach to resolving conflict and reaching consensus on end-of-life care. T...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.67.6.392
更新日期:2000-06-01 00:00:00
abstract::Thirty-four young patients (28 male and 6 female) underwent aortic valve replacement between 1972 and 1988. Ages ranged from 11 to 20 years (mean 17.7 years). Including reimplantation in the follow-up period, 40 valves were implanted, among which were 17 (43%) St. Jude, 7 (16%) Bjork-Shiley, and 4 (10%) Carpentier-Edw...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.59.5.473
更新日期:1992-09-01 00:00:00
abstract::Interleukin 1 (IL-1) is a potential target of therapy in COVID-19 during the severe respiratory-inflammatory phase ("cytokine release syndrome"), when pulmonary macrophages are hyperactivated, releasing IL-1 and other cytokines. Preliminary evidence indicates that anakinra and canakinumab, drugs that block the action ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.87a.ccc044
更新日期:2020-07-09 00:00:00
abstract::To date, there are no effective antiviral medications for COVID-19. Drug repurposing, a strategy that uses existing drugs, offers potential prevention and treatment options for COVID-19. We discuss one treatment strategy that combines anti-inflammatory (melatonin) and antiviral (toremifene) agents for patients infecte...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.87a.ccc037
更新日期:2020-06-30 00:00:00
abstract::Lifestyle factors remain the bedrock of atherosclerotic cardiovascular disease (ASCVD) prevention. Statins remain the first-line therapy for primary and secondary prevention of ASCVD. Physicians are encouraged to discuss the risks and benefits of statins with patients before beginning therapy. Nonstatins and proprotei...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.87.s1.02
更新日期:2020-05-01 00:00:00
abstract::Hirsutism is a source of significant anxiety in women. While polycystic ovary syndrome or other endocrine conditions are responsible for excess androgen in many patients, other patients have normal menses and normal androgen levels ("idiopathic" hirsutism). The goal of the evaluation is to rule out any underlying path...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.77a.08079
更新日期:2010-06-01 00:00:00
abstract::Recommendations exist for preparticipation physical examinations, but there is no national standard, and the recommendations are not widely followed. The most common reasons for denying clearance to play are musculoskeletal conditions, hypertension, and visual acuity problems. Although detecting potentially life-threa...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.71.7.587
更新日期:2004-07-01 00:00:00
abstract::Preliminary clinical trials suggest that therapeutic hypothermia might improve the outcomes of patients with acute stroke. Definitive trials are under way. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.69.10.770
更新日期:2002-10-01 00:00:00
abstract::Carefully designed, monitored rehabilitation regimens can benefit patients with significant cardiac disease, such as life-threatening arrhythmias or congestive heart failure, or who have concurrent systemic disease such as diabetes. Patients with heart failure can tolerate minimal workloads but, with conditioning, the...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.58.1.70
更新日期:1991-01-01 00:00:00
abstract::A surprising number of apparently healthy people harbor unsuspected pituitary tumors, which are being discovered incidentally on computed tomography (CT) or magnetic resonance imaging (MRI) performed for other reasons. The majority can be safely observed; for others, medical therapy or surgical resection is necessary....
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.75.11.793
更新日期:2008-11-01 00:00:00
abstract::Development of medical devices requires interaction between physicians and industry that is considerably more intimate than that in pharmaceutical development. Progress in procedure-based medicine would be stalled if this collaboration were eliminated. This degree of interaction, however, creates conflicts of interest...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.74.suppl_2.s26
更新日期:2007-03-01 00:00:00
abstract::A subdural empyema developed in a young man after craniotomy for evacuation of a hematoma in a sylvian fissure arachnoid cyst and the subdural space. Despite prolonged systemic and subdural antibiotic administration and a debridement of the subdural space, infection persisted, as evidenced by persistent fever, an elev...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.56.3.311
更新日期:1989-05-01 00:00:00
abstract::The American Heart Association issued a science advisory on depression and coronary heart disease (CHD) in 2008. This paper reviews the purpose and content of the advisory and discusses reactions and new information that have followed the advisory's release. Both the advisory and subsequent data support routine screen...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.77.s3.03
更新日期:2010-07-01 00:00:00
abstract::Abnormal hemodynamic responses to exercise treadmill testing may indicate an increased risk of coronary events and death, even if evidence of ischemia is absent. Exercise duration and the blood pressure, heart rate, and heart rhythm responses to exercise have prognostic significance. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.75.6.424
更新日期:2008-06-01 00:00:00
abstract::Epidemiologic and experimental data suggest that isoflavones have benefits for preventing and treating some prostate disease. Isoflavone supplements may therefore be an important tool for men concerned about prostate disease, such as those with benign prostatic hypertrophy undergoing watchful waiting or those concerne...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.70.3.203
更新日期:2003-03-01 00:00:00
abstract::The history and physical examination, rather than routine laboratory, cardiovascular, and pulmonary testing, are the most important components of the preoperative evaluation. The history should include a complete review of systems (especially cardiovascular and pulmonary), medication history, allergies, surgical and a...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.71.1.63
更新日期:2004-01-01 00:00:00
abstract::Vascular surgery is associated with a high risk of perioperative morbidity and mortality that is partly attributable to inflammatory stress induced by the surgical procedure. Preoperative initiation of a long-acting statin is a strategy intended to reduce the inflammatory stress response and the excess risk associated...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.76.s4.13
更新日期:2009-11-01 00:00:00
abstract::The article "Total pancreatectomy and islet cell autotransplantation: Definitive treatment for chronic pancreatitis" (Arce KM, Lin YK, Stevens T, Walsh RM, Hatipoglu BA. Cleve Clin J Med 2016; 83:435-442) incorrectly stated that Paul Lacy and David Scharp performed research at the University of Washington at Seattle. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 已发布勘误
doi:
更新日期:2016-09-01 00:00:00
abstract::The Internet can be useful for physicians, but beginning users are apt to encounter two problems: too much irrelevant information, and difficulty finding the desired information. This paper offers some practical tips that can prevent frustration and wasted time when searching for medical information on the Internet. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.66.9.543
更新日期:1999-10-01 00:00:00
abstract::Elderly patients pose unique challenges perioperatively. They are more likely than younger surgical patients to be mentally and physically compromised at baseline, which increases the risk of delirium and postoperative cognitive dysfunction. Postoperative cognitive risk can be predicted, however, and effective strateg...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.76.s4.03
更新日期:2009-11-01 00:00:00
abstract::Heart failure is the most important public health problem in cardiovascular medicine, and is increasing in both prevalence and expense. Programs that use an interdisciplinary team to improve outpatient treatment and prevent hospitalizations will help improve care and control costs. But the most important long-term str...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.65.7.351
更新日期:1998-07-01 00:00:00
abstract::The number of aorta procedures performed annually in the United States has grown substantially during the past decade. Cleveland Clinic is a leader in research on the risk of aortic dissection in patients with a bicuspid or tricuspid aortic valve and associated aneurysm, which has led to changes in the recommendations...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.84.s4.07
更新日期:2017-12-01 00:00:00
abstract::Ebola virus causes a hemorrhagic fever with a high case-fatality rate. Treatment remains supportive although a variety of specific treatments are still in the early stages of investigation. This report reviews the clinical virology of Ebola virus, the reported proposed treatments, and the current outbreak. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.81gr.14007
更新日期:2014-12-01 00:00:00
abstract::Increased levels of human growth hormone (HGH) may correlate with the severity of psoriasis and native somatostatin (SRIF) may improve it by inhibiting HGH release. The synthetic SRIF analog, SMS 201-995, is a potent and long-lasting HGH inhibitor. Nine patients with chronic plaque psoriasis completed 12 weeks of open...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章
doi:10.3949/ccjm.57.1.71
更新日期:1990-01-01 00:00:00
abstract::Genetics may account for much of the variability in our patients' responses to drug therapies. This article offers the clinician an up-to-date overview of pharmacogenomic testing, discussing implications and limitations of emerging validated tests relevant to the use of warfarin (Coumadin), clopidogrel (Plavix), stati...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.78a.10145
更新日期:2011-04-01 00:00:00
abstract::Cardiac rehabilitation, consisting of prescribed exercise and counseling for risk modification, has proven benefits for patients with cardiovascular disease. Nevertheless, rates of referral and use remain low. Efforts to increase program referral and participation are ongoing. ...
journal_title:Cleveland Clinic journal of medicine
pub_type: 杂志文章,评审
doi:10.3949/ccjm.85a.17037
更新日期:2018-07-01 00:00:00