Index 517 INDEX A AASK, see African-American Study of Kidney Disease ACE inhibitors, see Angiotensinconverting enzyme inhibitors ACS, see Acute coronary syndrome Acute coronary syndrome (ACS), classification and features, 243, 244 clinical presentation, 245 medical management, 246 mortality, 246, 247 non-st segment elevation myocardial infarction management, 244 revascularization, 246, 247 ST segment elevation myocardial infarction management, 245, 247 thrombolytic therapy, 247 unstable angina management, 243, 244, 249 Adherence, alternative therapy impact, 507 assessment, 505 frequency in elderly hypertensives, 502, 503 heart failure medications, 221 improvement strategies, 507 509 out-of-office blood pressure monitoring, 507 readiness to change assessment, 505 507 social support effects, 501 Adrenergic receptor blockers, see α-blockers; β-blockers AF, see Atrial fibrillation African-Americans, barriers in hypertension treatment, 429, 430 guidelines for hypertension management, 444 446 pharmacotherapy studies, angiotensin receptor blockers, 437 439 inhibitors, 434 437 β-blockers, 442, 443 calcium channel blockers, 439 441 combination therapy, 443, 444 diuretics, 431 434 African-American Study of Kidney Disease (AASK), findings, 434, 435, 437 Aging, cardiac function effects, cardiac output, 15, 16 heart rate, 15 left ventricular wall function, 16 myocardial contractility, 16, 17 classification of elderly, 230 demographics, 3, 11, 36 heart failure pathophysiology, 201, 202 life expectancy, 231 overview of cardiovascular effects, 11 13, 18, 19 pharmacodynamic effects, α-blockers, 44, 45 inhibitors, 43 517
518 Index angiotensin receptor blockers, 44 β-blockers, 45 calcium channel blockers, 45, 46 diuretics, 43 overview, 42, 43 pharmacokinetic effects, body weight compartmentalization, 38 distribution, 38 gut absorption, 36, 37 metabolism, kidney, 40 42 liver, 39, 40 protein binding, 38, 39 transdermal absorption, 37, 38 renal effects, 17, 18 vascular effects, arterial wall thickening and stiffening, 13 endothelial dysfunction, 13 15 Albumin:creatinine ratio, diabetic nephropathy screening, 459 Alcohol, reduction and hypertension reduction, 77 Aldosterone, see Hyperaldosteronism ALLHAT, see Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial α-blockers, α-adrenergic receptors, lumbosacral spinal cord receptors, 386 structure and activation, 383 385, 386 urinary bladder receptors, 386 vasculature receptor subtypes, 382, 383 benign prostatic hyperplasia management, 388, 390 cardiovascular disease reduction trials, 393 396 heart failure trials, 392, 393 hypertension management, 388, 390 lipid profile benefits, 392 pharmacodynamic changes in aging, 44, 45 side effects, edema, 391, 392 frequency, 390 laboratory test changes, 391 syncope, 391 structures, 389 sympathetic nervous system in hypertension, 382 types and receptor specificity, 386 388 Alzheimer s disease, see Dementia ANBP2, see Second Australian National Blood Pressure Study Anemia, angiotensin-converting enzyme inhibitor induction, 340 Angina, prevention and management, 236 243 unstable angina, see Acute coronary syndrome Angiotensin-converting enzyme (ACE) inhibitors, African-American hypertension control studies, 434 437 combination therapy, calcium channel blockers, 412, 413, 415, 417, 418 diuretics, 410, 412 diabetic hypertensive management, 460 economic considerations, 325, 326 enzyme gene polymorphisms, 335
Index 519 heart failure management, 210, 211, 220, 221, 335, 336 hemodynamic effects, 327, 328 hypertension management, associated disorders, 332, 333 combination therapy, 331, 332 monotherapy, 327 330 indications, 330 mechanism of action, 326, 327 myocardial infarction management, 336, 337 organ protection, heart, 335 337 kidney, 333 335 pharmacodynamic changes in aging, 43 pharmacology, class effects, 326 elimination route, 323 prodrugs, 322 structures, 322, 323 tissue binding, 323, 325 renovascular hypertension management, bilateral disease, 185 unilateral disease, 183, 184 side effects, 339, 340 stroke prevention, 337 339 types and dosing, 324, 329, 330 Angiotensin receptor blockers (ARBs), adverse effects, 352, 363, 364 African-American hypertension control studies, 437 439 candesartan, 352, 354 clinical trials, overview of outcomes, 349 351 diabetic hypertensive management, 460 462 eprosartan, 355, 356 heart failure management, 214 216 irbesartan, 356, 357 losartan, 357 359 olmesartan, 359, 360 pharmacodynamic changes in aging, 44 telmisartan, 360, 361 types and dosing, 352, 353 valsartan, 361 364 ANP, see Atrial natriuretic peptide Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), African-American hypertension control findings, 431 433, 440 α-blocker findings, 393 395 ANBP2 comparison, 307, 308 β-blocker and diuretic findings, 304 307, 311 calcium channel blocker findings, 375, 377 diabetes findings, 456 overview of findings, 7, 108, 109 Aorta, hypertension effects, 7, 8 ARBs, see Angiotensin receptor blockers Arteriosclerosis, aging effects, 13, 27 blood pressure, effects of arterial stiffening, 26 28 response to vasodilation, 31 pulse wave velocity measurement, 28 30, 33 Arthritis, epidemiology, 471, 472 nonsteroidal anti-inflammatory drugs and cyclooxygenase- 2 inhibitors, blood pressure effects, dysregulation, 477, 479 fluid and electrolyte imbalance, 479 481 hypertension induction and mechanisms, 474 476 celecoxib safety, 485, 486
520 Index prevalence of use, 472 prostaglandin roles in hypertension and renal insufficiency, 472, 473 renal damage, 482 484 rofecoxib safety, 485 valdecoxib safety, 485, 486 Aspirin, angina prevention and management, 240, 241 diabetic patient management, 463, 464 Atrial fibrillation (AF), aging risks, 267 stroke association, 267, 268 Atrial natriuretic peptide (ANP), hypertension role in hyperaldosteronism, 156 Auscultatory gap, error sources in blood pressure measurement, 120, 121 B Benign prostatic hyperplasia (BPH), α-blocker management, 388, 390 β-blockers, adverse effects, 312, 313 African-American hypertension control studies, 442, 443 angina prevention and management, 241 cardiovascular risk reduction, clinical trials, 298 301 combination therapy trials, ALLHAT, 304 308, 311 Second Australian National Blood Pressure Study, 307, 308 comparison with other antihypertensive agents, 302 304 diuretic comparison, 301, 302 meta-analysis of class comparisons, 308, 309 class effects and dosage, 309, 310 combination therapy, calcium channel blockers, 409, 410, 418, 419 diuretics, 407, 408 economic considerations, 314, 315 heart failure management, 211 214 indications, 312 metabolic effects, 313, 314 pharmacodynamic changes in aging, 45 types and dosing, 299 Bisoprolol, heart failure management, 212 Blood pressure, see also Diastolic blood pressure; Systolic hypertension, ambulatory monitoring, advantages, 128 frequency, 127, 128 indications and clinical utility, 129, 130 components, 59 monitoring guidelines in normotensive elderly, 55 nonsteroidal anti-inflammatory drugs and cyclooxygenase- 2 inhibitor effects, dysregulation, 477, 479 fluid and electrolyte imbalance, 479 481 hypertension induction and mechanisms, 474 476 office measurement, auscultatory gap, 120, 121 masked hypertension, 124 orthostatic blood pressure changes, 121, 122 pseudohypertension, 122, 123 technique, 136 138 white-coat effect and hypertension, 123, 124
Index 521 self-measurement, devices, 125, 126 frequency, 126 indications, 126, 127 normal values, 126 targets, 63 BNP, see Brain natriuretic peptide BPH, see Benign prostatic hyperplasia Brachial artery, palpation, 137 Brain natriuretic peptide (BNP), heart failure evaluation, 207 Bruit, hypertension evaluation, 141 C CABG, see Coronary artery bypass grafting Caffeine, avoidance and hypertension reduction, 77 Calcium, supplementation and hypertension reduction, 74, 75 Calcium channel blockers, adverse effects, 379 African-American hypertension control studies, 439 441 clinical trials, active control comparator trials, 374, 375 ALLHAT findings, 375, 377 CONVINCE findings, 377, 378 overview, 371, 372 placebo-controlled trials, 372 374 combination therapy, inhibitors, 412, 413, 415, 417, 418 β-blockers, 409, 410 diuretics, 418, 419 controversy in hypertension management, 370, 371 pharmacodynamic changes in aging, 45, 46 Candesartan, hypertension treatment efficacy, 354 pharmacokinetics, 352, 354 stroke prevention, 354 CAPPP, see Captopril Prevention Program Captopril Prevention Program (CAPPP), findings, 302, 333, 338 Captopril renal scintigraphy, renovascular hypertension, 179, 180 Cardiac output, aging effects, 15, 16 wasting in systolic hypertension, 32 Cardiovascular disease (CVD), see also Acute coronary syndrome, age as risk factor, 11, 53, 54 angina prevention and management, 236 243 diabetes as risk factor, 451, 452 hypertension as risk factor, 55 58 left ventricular hypertrophy as risk factor, 56 58 mortality, 230 overview, 229, 230 prevention, 230 235 subclinical disease, 235, 236 Cardiovascular Study in the Elderly (CASTEL), findings, 98, 99 Carvedilol, heart failure management, 212, 213 CASTEL, see Cardiovascular Study in the Elderly Celecoxib, safety studies, 485, 486 Cerebrovascular disease, see Stroke Chlorthalidone, dosing, 310 Clinical trials, see also specific drug classes and trials, calcium channel blockers, active control comparator trials, 374, 375
522 Index ALLHAT findings, 375, 377 CONVINCE findings, 377, 378 overview, 371, 372 placebo-controlled trials, 372 374 comparisons of antihypertensive treatment efficacies, 110 112 design of studies, 91 heart failure management, 207 210, 219, 220 prospective trial overview, 91 93 Clopidogrel, angina prevention and management, 241 Combination therapy, inhibitor combinations, calcium channel blockers, 412, 413, 415, 417, 418 diuretics, 410, 412 β-blocker combinations, calcium channel blockers, 409, 410, 418, 419 diuretics, 407, 408 calcium channel blocker combinations, inhibitors, 412, 413, 415, 417, 418 β-blockers, 409, 410 diuretics, 418, 419 diuretic combinations, angiotensin-converting enzyme inhibitors, 410, 412, 417 β-blockers, 407, 408 potassium-sparing diuretics and hydrochlorothiazide, 407 fixed-dose combination products, 402, 404 hypertension control rates, 400, 402 Joint National Committee algorithm for hypertension treatment, 400 402 rationale and overview, 400, 402, 405, 406 Compliance, see Adherence Computed tomography (CT), dementia, 278, 279 spiral computed tomographic angiography of renovascular hypertension, 183 Congestive heart failure, see Heart failure Controlled Onset Verapamil Investigation of Cardiovascular End Points (CONVINCE), findings, 303, 377, 378 CONVINCE, see Controlled Onset Verapamil Investigation of Cardiovascular End Points Coronary artery bypass grafting (CABG), outcomes in elderly patients, 242, 243 Cortisol, see Cushing s syndrome Cough, angiotensin-converting enzyme inhibitor induction, 339, 340 COX-2 inhibitors, see Cyclooxygenase-2 inhibitors CT, see Computed tomography Cushing s syndrome, classification, 160, 161 epidemiology, 162, 163 management and hypertension treatment issues, 163 pathogenesis of hypertension, 161 CVD, see Cardiovascular disease Cyclooxygenase-2 (COX-2) inhibitors, blood pressure effects, dysregulation, 477, 479
Index 523 fluid and electrolyte imbalance, 479 481 hypertension induction and mechanisms, 474 476 cyclooxygenase isoforms, 472 prevalence of use, 472 prostaglandin roles in hypertension and renal insufficiency, 472, 473 renal damage, 482 484 safety studies, celecoxib, 485, 486 rofecoxib, 485 valdecoxib, 485, 486 D DBP, see Diastolic blood pressure Dementia, Alzheimer s disease, 275 clinical features, 273, 274 definition, 272 diagnosis, 274 epidemiology, 273 etiology, 273 hypertension, management in dementia prevention, 284 286 risk factor evidence, 280, 283 mild cognitive impairment versus dementia, 274, 275 multi-infarct dementia, 276 neuroimaging, 278 284 neuropathology, 284 neuropsychological testing, 277, 278 vascular dementia, 276, 277 Demographics, aging population, 3, 11, 36 Diabetes mellitus, aspirin therapy, 463, 464 cardiovascular disease risks, 451, 452 hypertension, association and cardiovascular risks, 62, 452 454, 456 blood pressure goals, 463 lifestyle modification in management, 463 treatment in diabetic nephropathy, 458 462 insulin resistance mechanisms in hypertension, 453, 454 metabolic effects of antihypertensive drugs, 313, 314 stroke risks, 258, 456 458 Diastolic blood pressure (DBP), aging effects, 24 hypertension epidemiology, 55 monotherapy control rate, 400, 403 Digoxin, heart failure management, 218 Diuretics, adverse effects, 312, 313 African-American hypertension control studies, 431 434 cardiovascular risk reduction, β-blocker comparison, 301, 302 clinical trials, 298 301 combination therapy trials, ALLHAT, 304 308, 311 Second Australian National Blood Pressure Study, 307, 308 comparison with other antihypertensive agents, 302 304 meta-analysis of class comparisons, 308, 309 class effects and dosage, 309, 310 combination therapy, inhibitors, 410, 412, 417 β-blockers, 407, 408 potassium-sparing diuretics and hydrochlorothiazide, 407
524 Index economic considerations, 314, 315 indications, 312 metabolic effects, 313, 314 pharmacodynamic changes in aging, 43 types and dosing, 299 Dyslipidemia, α-blocker benefits, 392 stroke risks, 258, 259 E Echocardiography, heart failure evaluation, 204, 205 Edema, α-blocker induction, 391, 392 Electrocardiography, hypertension evaluation, 142 ELITE, see Evaluation of Losartan in the Elderly End-stage renal disease (ESRD), see also Renovascular hypertension, hypertension association and cardiovascular risks, 62 hypertension treatment in diabetic nephropathy, 458 462 prognosis, 171 Eplerenone, African-American hypertension control findings, 434 heart failure management, 216, 217 Eprosartan, hypertension treatment efficacy, 355, 356 pharmacokinetics, 355 ESRD, see End-stage renal disease European Working Party on High Blood Pressure in the Elderly (EWPHE), findings, 94 Evaluation of Losartan in the Elderly (ELITE), findings, 357, 358 EWPHE, see European Working Party on High Blood Pressure in the Elderly Exercise, angina prevention and management, 240 hypertension reduction, 76, 77 F Fish oil, hypertension reduction, 77 H HCTZ, see Hydrochlorothiazide Healthy People 2010, blood pressure control goals, 510 512 Heart failure, Cardiovascular Health Study findings, 199 201 diagnosis, brain natriuretic peptide testing, 207 echocardiography, 204, 205 systolic versus diastolic failure, 203, 204 economic impact, 199, 495 epidemiology, 197 201 etiology in aging, 202, 203 mortality, 197 pathophysiology in aging, 201, 202 prevention, 221, 222 treatment, adherence, 221 angiotensin receptor blockers, 214 216 inhibitors, 210, 211, 220, 221 β-blockers, 211 214 clinical trials, overview and limitations, 207 210, 219, 220 diastolic heart failure, 220, 221 digoxin, 218
Index 525 eplerenone, 216, 217 hydralazine, 217, 218 irbesartan, 220 isosorbide dinitrate, 217, 218 spironolactone, 216, 217 Heart rate, aging effects, 15 Heart sounds, hypertension evaluation, 140 HEP, see Hypertension in the Elderly in Primary Care trial History, medical history in hypertension evaluation, 138 140 HOT, see Hypertension Optimal Treatment study Hydralazine, heart failure management, 217, 218 Hydrochlorothiazide (HCTZ), adverse effects, 312, 313 combination therapy with potassium-sparing diuretics, 407 dosing, 310 stroke risk reduction, 270 Hyperaldosteronism, aldosterone functions, 154, 155 epidemiology, 156 159 management and hypertension treatment issues, 159, 160 pathogenesis of hypertension, 155, 156 Hyperkalemia, angiotensin-converting enzyme inhibitor induction, 339 Hypertension, see Systolic hypertension Hypertension in the Elderly in Primary Care trial (HEP), findings, 94 Hypertension in the Very Elderly Trial (HYVET), findings, 106 108 Hypertension Optimal Treatment study (HOT), diabetes findings, 454 Hyperthyroidism, epidemiology, 151, 152 management and hypertension treatment issues, 152, 154 pathogenesis of hypertension, 149 151 Hypothyroidism, epidemiology, 151, 152 management and hypertension treatment issues, 152, 154 pathogenesis of hypertension, 149 151 HYVET, see Hypertension in the Very Elderly Trial I INSIGHT, findings, 304, 374, 375 International Verapamil- Trandolapril Study (IN VEST), findings, 304 INVEST, see International Verapamil-Trandolapril Study Irbesartan, heart failure management, 220 hypertension treatment efficacy, 356, 357 pharmacokinetics, 356 Isosorbide dinitrate, heart failure management, 217, 218 J JNC, see Joint National Committee Joint National Committee (JNC), algorithm for hypertension treatment, 400 402 L Labetalol, adrenergic receptor specificity, 388 Laboratory studies, hypertension evaluation, 141, 142 Left ventricular hypertrophy (LVH), see also Heart failure, cardiovascular disease risk factor, 56 58 hypertension in etiology, 56 58 stroke risks, 260
526 Index LIFE, see Losartan Intervention for Endpoint reduction study Lifestyle modification, diabetics, 463 guidelines for hypertension control, 69, 70 randomized trials of benefits, alcohol reduction, 77 caffeine avoidance, 77 calcium supplementation, 74, 75 early studies, 70, 71 exercise, 76, 77 fish oil, 77 magnesium supplementation, 78 potassium supplementation, 73, 74 sodium restriction, 71 73, 79, 81, 82, 85 Trial of Nonpharmacological Intervention in Elderly, 78 85 vitamin C supplementation, 75, 76 Losartan Intervention for Endpoint reduction study (LIFE), findings, 304 hypertension treatment efficacy, 357 359 pharmacokinetics, 357 stroke risk reduction, 270, 271 LVH, see Left ventricular hypertrophy M Magnesium, supplementation and hypertension reduction, 78 Magnetic resonance angiography (MRA), renovascular hypertension, 183 Magnetic resonance imaging (MRI), dementia, 278, 279, 282 284 silent cerebral infarction, 270 MAP, see Mean arterial pressure Masked hypertension, features, 124, 129, 130 Mean arterial pressure (MAP), calculation, 26 Medical Research Council trial in older adults, findings, 97, 98 Metoprolol, heart failure management, 212 MI, see Myocardial infarction Mini-Mental Status Exam (MMSE), dementia screening, 278 MMSE, see Mini-Mental Status Exam MRA, see Magnetic resonance angiography MRI, see Magnetic resonance imaging Myocardial infarction (MI), see also Cardiovascular disease, inhibitor management, 336, 337 morbidity in the elderly, 54 mortality in the elderly, 54, 243 N National Intervention Cooperative Study in Elderly Hypertensives (NICS-EH), findings, 102, 103 NICS-EH, see National Intervention Cooperative Study in Elderly Hypertensives Nonsteroidal anti-inflammatory drugs (NSAIDs), see also Cyclooxygenase-2 inhibitors, antihypertensive drug interactions, 478 blood pressure effects, dysregulation, 477, 479 fluid and electrolyte imbalance, 479 481 hypertension induction and mechanisms, 474 476
Index 527 prevalence of use, 472 prostaglandin roles in hypertension and renal insufficiency, 472, 473 renal damage, 482 484 Nordic Diltiazem study (NORDIL), findings, 302, 374, 375 NORDIL, see Nordic Diltiazem study NSAIDs, see Nonsteroidal antiinflammatory drugs O Olmesartan, hypertension treatment efficacy, 359, 360 pharmacokinetics, 359 Orthostatic hypotension, blood pressure measurement considerations, 121, 122 epidemiology, 135, 136 P PAD, see Peripheral arterial disease PCI, see Percutaneous coronary intervention Percutaneous coronary intervention (PCI), acute coronary syndrome management, 246 28 outcomes in elderly patients, 241, 242 Percutaneous transluminal renal angioplasty (PTRA), renovascular hypertension management, 185, 187 Perindopril, stroke risk reduction, 271, 272 Perindopril Protection Against Recurrent Stroke Study (PROGRESS), findings, 284, 285, 338 Peripheral arterial disease (PAD), inhibitor effects, 333 Pharmacokinetics, aging effects, angiotensin receptor blockers, see specific drugs inhibitors, see Angiotensin-converting enzyme inhibitors body weight compartmentalization, 38 distribution, 38 gut absorption, 36, 37 metabolism, kidney, 40 42 liver, 39, 40 protein binding, 38, 39 transdermal absorption, 37, 38 Pheochromocytoma, clinical features, 164 epidemiology, 164 management and hypertension treatment issues, 164, 165 pathogenesis of hypertension, 164 Physical examination, hypertension evaluation, 140, 141 Potassium, supplementation and hypertension reduction, 73, 74 PP, see Pulse pressure Pravastatin, angina prevention and management, 239 PROGRESS, see Perindopril Protection Against Recurrent Stroke Study Prostaglandins, roles in hypertension and renal insufficiency, 472, 473 synthesis, 472 Pseudohypertension, evaluation, 122, 123 PTRA, see Percutaneous transluminal renal angioplasty Pulse pressure (PP), amplification in arteriosclerosis, 29, 30
528 Index cardiovascular risks of wide pulse pressure in aging, 24, 25, 59, 64 central arterial stiffness effects, 26 28 Pulse wave velocity (PWV), arteriosclerosis assessment, 28 30, 33 PWV, see Pulse wave velocity R Radial artery, palpation, 137 Ramipril, stroke risk reduction, 271 Reduction of Endpoints in NIDDM with Angiotensin Antagonist Losartan (RENAAL), findings, 461 RENAAL, see Reduction of Endpoints in NIDDM with Angiotensin Antagonist Losartan Renin, renal vein renin test, 181, 183 Renovascular hypertension (RVH), definition, 176 diagnosis, captopril renal scintigraphy, 179, 180 Doppler ultrasound, 180, 181 magnetic resonance angiography, 183 renal vein renin test, 181, 183 spiral computed tomographic angiography, 183 epidemiology, 176 178 natural history, 178 pathogenesis, 178, 179 prognosis, 178 renal parenchymal disease, diagnosis, 174, 175 epidemiology, 172 hypertension management, 175, 176 pathogenesis, 172, 174 treatment, algorithm, 188, 189 bypass, 188 goals, 171, 172 percutaneous transluminal renal angioplasty, 185, 187 pharmacotherapy, bilateral disease, 185 unilateral disease, 183, 184 stenting, 187, 188 Rofecoxib, safety studies, 485 RVH, see Renovascular hypertension S SCOPE, see Study on Cognition and Prognosis in the Elderly Second Australian National Blood Pressure Study (ANBP2), ALLHAT comparison, 307, 308 findings, 103, 104, 307 Secondary hypertension, endocrine causes, Cushing s syndrome, 160 163 hyperaldosteronism, 154 160 pheochromocytoma, 163 166 thyroid hormone derangements, 147, 149 152, 154 epidemiology, 145 147 Shanghai Trial of Nifedipine in the Elderly (STONE), findings, 99 SHELL, see Systolic Hypertension in the Elderly: Lacidipine Long-Term Study SHEP, see Systolic hypertension in the Elderly Program Simvastatin, angina prevention and management, 241 Smoking cessation, cardiovascular benefits, 238 Sodium, restriction and hypertension reduction, 71 73, 79, 81, 82, 85
Index 529 Spironolactone, heart failure management, 216, 217 Statins, angina prevention and management, 238 241 Stenting, renovascular hypertension management, 187, 188 Stiffness, arterial, see Arteriosclerosis STONE, see Shanghai Trial of Nifedipine in the Elderly STOP-Hypertension, see Swedish Trial in Old Patients with Hypertension trial STOP-Hypertension-2, see Swedish Trial in Old Patients with Hypertension-2 trial Stroke, inhibitor prevention, 337 339 epidemiology, 255, 256 hemorrhagic stroke, intraparenchymal hemorrhage, 262 265 pathophysiology, 257, 258 subarachnoid hemorrhage, 260 262 hypertension management in prevention, 270 272 ischemic stroke, embolic stroke, 267, 268 lacunar infarction, 268, 269 large artery atherosclerosis, 265, 266 silent cerebral infarction, 270 mortality, 255, 256 multi-infarct dementia, 276 outcomes in the elderly, 256 recurrence rates, 259 risk factors, age, 258 cardiac disease, 258 diabetes, 258, 456 458 dyslipidemia, 258, 259 hypertension, 255, 258 260 left ventricular hypertrophy, 260 smoking, 258 Study on Cognition and Prognosis in the Elderly (SCOPE), findings, 104, 105 Subarachnoid hemorrhage, see Stroke SVR, see Systemic vascular resistance Swedish Trial in Old Patients with Hypertension trial (STOP- Hypertension), findings, 95, 96 Swedish Trial in Old Patients with Hypertension-2 trial (STOP- Hypertension-2), findings, 101, 102, 304, 374 Syncope, α-blocker induction, 391 Syst-China, see Systolic Hypertension in China trial Systemic vascular resistance (SVR), aging effects, 26 Syst-Eur, see Systolic Hypertension in Europe trial Systolic hypertension, aging effects, 24, 55 awareness, 496, 510 benefits of control, 25 cardiovascular risks in aging, 23, 24, 32, 59, 60, 62 classification, 25 control prospects, awareness increase, 510 health care reimbursement changes, 511 therapeutic tools and strategies, 511 control rates, 496 498, 509 epidemiology, 3 6 pathophysiology, central arterial stiffness, 26 30 integrated hemodynamic model, 30, 31
530 Index pulsatility and blood flow, 26 steady-state hemodynamics, 26 wasted cardiac output, 32 patient factors in control, adherence, 501 503 attitudes, 499 comorbid depression or alcoholism, 502 continuous primary care access, 501, 502 cost limitations, 502, 503 health discount rates, 501 health literacy, 500 knowledge, 499, 500 overview, 498 self-efficacy levels, 501 social support, 501 prevalence and significance in the elderly, 3, 4, 59, 494, 495 provider factors in control, adherence improvements, 507 509 assessments, 505 507 chart audit and feedback, 504 individualized therapy, 504, 505 interview styles and communication patterns, 508 risk stratification, 59, 60, 62 stroke risks, 259, 260 treatment goals, 494, 510 Systolic Hypertension in China trial (Syst-China), findings, 101, 237, 372, 373 Systolic Hypertension in the Elderly: Lacidipine Long-Term Study (SHELL), findings, 105, 106 Systolic hypertension in the Elderly Program (SHEP), findings, 94, 95, 374, 432, 433 Systolic Hypertension in Europe trial (Syst-Eur), findings, 99 101, 237, 373 T Taste loss, angiotensin-converting enzyme inhibitor induction, 340 Telmisartan, hypertension treatment efficacy, 360, 361 pharmacokinetics, 360 Thrombolytic therapy, acute coronary syndrome management, 247, 248 risks in elderly patients, 247, 248 Thyroid hormone, cardiovascular effects, 149 derangements, see Hyperthyroidism; Hypothyroidism functions, 147 TONE, see Trial of Nonpharmacological Intervention in Elderly Trial of Nonpharmacological Intervention in Elderly (TONE), end points, 78 overview, 78 sodium excretion rate, 83, 84 sodium restriction effects, 79, 81, 82, 85 study populations, 79 weight loss effects, 81, 82 U UKPDS, see United Kingdom Prospective Diabetes Study Ultrasound, renovascular hypertension evaluation with Doppler ultrasound, 180, 181 United Kingdom Prospective Diabetes Study (UKPDS), findings, 454, 457
Index 531 V Valdecoxib, safety studies, 485, 486 Valsartan, adverse effects, 363, 364 hypertension treatment efficacy, 361 364 pharmacokinetics, 361 Vascular dementia, see also Dementia, diagnostic criteria, 277 hypertension role, 128 Verapamil, see Controlled Onset Verapamil Investigation of Cardiovascular End Points; International Verapamil- Trandolapril Study Vitamin C, supplementation and hypertension reduction, 75, 76 W White-coat hypertension, ambulatory blood pressure monitoring, 129 features, 123, 124 reversed white-coat effect, 124, 129, 130