News in the treatment of hypertension in the context of metabolic syndrome in older patients.
Authors:
M. Souček; I. Řiháček; P. Fráňa; M. Plachý
Authors‘ workplace:
II. interní klinika LF MU a FN U sv. Anny v Brně
Published in:
Čes Ger Rev 2009; 7(3-4): 117-122
Overview
Patients with hypertension and metabolic syndrome deserve maximum attention considering the high prevalence of this polymorbidity in the population and high incidence of target organ damage. Non-pharmacological treatment should be preferred in these patients unless blood pressure levels are 140/90 mm Hg and higher, in which case pharmacological treatment should always be used. Rennin‑angiotenzin axis blockers (inhibitors ACE, sartans) represent the first line treatment. This treatment should be insufficient, the first line drugs are combined with calcium channel blockers, centrally acting drugs or, alternatively, small dose of a thiazide diuretic or indapamide. The HYVET study provided evidence on the treatment of hypertension in older patients.
Keywords:
metabolic syndrome – hypertension – combination therapy
Sources
1. Muntner P, He J, Chen J et al. Prevalence of non‑traditional cardiovascular disease risk factors among persons with imapaired fasting glucose, impaired glucose tolerance, diabetes, and the metabolic syndrome: analysis of the Third National Health and Nutrition Examination Survey (NHANES III). Ann Epidemiol 2004; 14: 686–695.
2. Kereiakes DJ, Willerson JT. Metabolic syndrome epidemic. Circulation 2003; 108 (13): 1552–1553.
3. Cífková R, Škodová Z, Lánská V et al. Trends in blood pressure levels, prevalence, awareness treatment, and control of hypertension in the Czech population from 1985 to 2000/2001. J Hypertens 2004; 22: 1479–1485.
4. Mancia G, Parati G, Borghi C et al. SMOOTH investigators. Hypertension prevalence, awareness, control and association with metabolic abnormalities in the San Marino population: the SMOOTH study. J Hypertens 2006; 24: 837–843.
5. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III ). JAMA 2001; 285 (19): 2486–2497.
6. Mancia G, De Backer G, Dominiczak A et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25 (6): 1105–1187.
7. Tuomilehto J, Lindström J, Eriksson JG et al. Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344 (18): 1343–1350.
8. Cífková R. Hypertenze a metabolický syndrom. In: Widimský Ja kol. Hypertenze. 3. rozšířené a přepracované vyd. Praha: Triton 2008.
9. Widimský J jr, Cífková R, Špinar J et al. Doporučení diagnostických a léčebných postupů u arteriální hypertenze – verze 2007. Doporučení České společnosti pro hypertenzi. Vnitř Lék 2008; 54 (1): 101–118.
10. Conroy RM, Pyörälä K, Fitzgerald AP et al. Estimation of ten- risk of fatal cardiovascular disease in Europe: the SCORE Project. Eur Heart J 2003; 24 (11): 987–1003.
11. Hansson L, Lindholm LH, Niskanen L et al. Effect of angiotensin‑converting enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPP) randomised trial. Lancet 1999; 353: 611–616.
12. Dahlöf B, Lindholm LH, Hansson L et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP- Hypertension). Lancet 1991; 338: 1281–1285.
13. UK rospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complication in Type 2 diabetes. UKPDS38. BMJ 1998; 317 (7160): 703–713.
14. Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin‑converting‑enzyme inhibotor Ramipril on cardiovascular events in high risk patients. The Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. N Engl J Med 2000; 324 (3): 145–153.
15. Nadar S, Lim HS, Beevers DG et al. Lipid lowering in hypertension and heart protection: observation from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) and the Heart Protection Study. J Hum Hypertens 2002; 16 (17): 815–817.
16. Jamerson KA, on behalf of the ACCOPLISH investigators. Avoiding cardiovascular events in combination therapy in patients living with systolic hypertension. Illinois: American College of Cardiology Scientific Sessions 2008.
17. Patel A and ADVANCE Collaborating Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients type 2 diabetes mellitus (the ADVANCE trial): a randomized controlled trial. Lancet 2007; 370 (9590): 829–840.
18. Jamerson K, Weber MA, Bakris GL et al. Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients. N Engl J Med 2008; 359: 2417–2428.
19. Fox KM. EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double‑blind, placebo controlled, multicentre trial (the EUROPA study). Lancet 2003; 362 (9386): 782–788.
20. The Advance Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370: 829–840.
21. Beckett NS, Peters R, Fletcher AE et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med 2008; 358: 1887–1898.
22. Nevrlka J, Souček M. Metabolický syndrom a hypertenze. Remedia 2006; 16 (2): 146–151.
Labels
Geriatrics General practitioner for adultsArticle was published in
Czech Geriatric Review
2009 Issue 3-4
Most read in this issue
- Social care benefits for seniors with dementia syndrome
- Sleep disorders and treatment of sleep disorders in Inpatient Gerontopsychiatric Wards of Mental Health Hospital Kroměříž.
- Options for modifying behavioural problems in old age
- Diabetic nephropathy and accompanying renal impairment in older age