The quantitative aspects and dynamics of the circulatory mechanism in arterial hypertension

Isolated systolic hypertension in the elderly: pathophysiology and treatment

Isolated systolic hypertension (ISH) is a common clinical finding in the elderly population and appears to be a risk factor for cardiovascular morbidity and mortality. It appears feasible and safe to treat patients with various antihypertensive drugs; however, the morbidity and mortality benefits still need to be determined.

A study of comparative blood pressure measures in predicting risk of coronary heart disease

The Western Collaborative Group Study is a prospective study of 3,154 employed men, aged 39-59 years. Coronary heart disease (CHD) occurred in 257 subjects during 8.5 years of follow-up. The multiple logistic risk model was used to assess the comparative strength of systolic, diastolic, mean arterial and pulse pressure for the prediction of CHD in two age decades after adjustment for age, serum cholesterol, cigarette smoking, behavior pattern and weight. The risk of CHD was more strongly associated with the systolic than the diastolic pressure. The general practice of assessing the importance of blood pressure based only on the diastolic component should be reassessed.

A hemodynamic comparison of essential and renovascular hypertension. Cardiac output and total peripheral resistance: supine and tilted patients

Systemic hemodynamic measurements were obtained in 15 normal subjects and 30 untreated hypertensive patients (15 with essential hypertension and 15 with fibrosing stenosis of renal arteries). The essential hypertensives were selected from a larger group solely on the basis of matching their mean arterial pressures and ages with those of the patients with renal arterial disease in matched pairs; cardiac index was consistently higher in patients with renovascular hypertension than in those with essential hypertension. The higher cardiac output was maintained in the group with renal arterial disease even when reduced by tilting the subjects to a 50° head-up position. Total peripheral resistance was increased in both hypertensive groups. The low cardiac indices and mean rates of left ventricular ejection found in essential hypertension may also implicate the heart in this form of hypertension. Hence, increased total peripheral resistance, long thought to be the hemodynamic hallmark of hypertension, may not be the sole systemic abnormality; cardiac output may be increased in renal arterial disease and even reduced in essential hypertension.