The American journal of medicine
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There are few studies devoted specifically to the epidemiology of older hypertensive patients, although some information has been obtained from broader trials in which either the study populations have become older or an older subgroup has been identified. Three areas have been addressed: the changes of blood pressure with age; the prevalence of hypertension in older persons; and the risks of elevated blood pressure in elderly patients. It has been found that blood pressure, especially systolic pressure, increases with age. ⋯ Older hypertensive patients' risks of cardiovascular complications and death are from two to five times that of normotensive persons. Treatment of diastolic hypertension in older patients can be expected to delay the onset of cardiovascular disease and improve the quality of life. Hopefully, this will prove to be true for isolated systolic hypertension as well.
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Comparative Study Clinical Trial Controlled Clinical Trial
Lisinopril versus placebo in older congestive heart failure patients.
This article reports the results of a multicenter international study of the use of lisinopril in patients with congestive heart failure also receiving digoxin, diuretics, or both. Two thirds of the 130 subjects enrolled in the study received lisinopril and one third received placebo. Lisinopril treatment led to a significant improvement in both bicycle and treadmill exercise tolerance, New York Heart Association classification status, cardiac function assessed noninvasively, and symptomatology. ⋯ These changes, however, were not significantly different from those seen with placebo. Apart from one patient in whom hypotension developed followed by reversible renal failure, there were no serious adverse effects, and the incidence of sudden death and biochemical abnormalities was no different from that seen with placebo. This study confirms that this agent is an effective, safe, well-tolerated agent in the treatment of congestive cardiac failure and is equally applicable to younger and older patients.
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Hypertension is a major health problem for patients over 65 years of age. Control of elevated blood pressure reduces cardiovascular morbidity and mortality rates among older hypertensive patients. Increased total peripheral vascular resistance is the primary hemodynamic abnormality in these patients. ⋯ The latter condition might be thought to favor blood pressure control with diuretics and impair the response to angiotensin-converting enzyme inhibitor therapy. However, recent studies with lisinopril, a new long-acting, nonsulfhydryl angiotensin-converting enzyme inhibitor, indicate that reductions in systolic and diastolic blood pressure in older hypertensive patients receiving either angiotensin-converting enzyme inhibitor or hydrochlorothiazide monotherapy were not significantly different. These data demonstrate that angiotensin-converting enzyme inhibitor monotherapy can effectively lower blood pressure in older hypertensive patients.
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Pharyngitis, bronchitis, and pneumonia represent the most common respiratory tract infections. With a view to establishing effective management strategies, the origins of these illnesses and the diagnostic techniques that have been developed to discover them are reviewed. Therapeutic regimens with documented efficacy are outlined with emphasis on specific rather than empiric treatment. Although many respiratory tract pathogens remain exquisitely sensitive to penicillin, the emergence of resistant strains underscores the need for safe and effective alternative therapies.
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Currently used methods to determine glycemia have certain disadvantages, including cost, heavy labor involvement, and storage problems. Determination of serum fructosamine levels, on the other hand, offers several potential advantages over these current measures. Our goal was to evaluate the utility of serum fructosamine as a measure of glycemia. ⋯ Assay of serum fructosamine appears to be comparable to that of HbA1C for determination of glycemic control. The automaticity, reproducibility, and lower cost for the fructosamine assay argue strongly in favor of this assay in comparison to those for other glycosylated proteins.