BP In Elderly Patients With ISH

Table of Contents

Question:

Talk about Herapeutic Options to Reduce BP in Elderly Patients using ISH.

Answer:

Introduction

Hypertension in the elderly can lead to high sodium sensitivity and isolated systolichypertension (ISH).

People over 50 years old are more at risk for ISH due to a rise in systolic and decrease in diastolic blood pressure.

ISH is when the systolic blood pressure is higher than 140 mm Hg, and the diastolic is lower than 90 mmHg (1).

An increase in systolic bloodpressure can lead to cardiovascular disease and renal disease.

ISH can also be seen in high cardiac output conditions like hyperthyroidism and aortic insufficiency.

This condition is more common in the elderly because of decreased elasticity, arterial elastin degradation and arterial calcium accumulation (2).

As it increases mortality and morbidity associated with cardiovascular disease, systolic Hypertension can cause increased arterial stiffness.

There are many options available for elderly with ISH. These options may include pharmacological or non-pharmacological treatments.

This report will examine research articles on therapeutic interventions to treat ISH in the elderly. It will also discuss the benefits and drawbacks of each method for elderly patients.

Methodology and Results

A review of the literature on ISH suggests three options for lowering blood pressure in elderly patients.

These are cholecalciferol therapy, arteriovenous anastomosis, and other pharmacological interventions.

One research article utilized a placebo-controlled randomized trial to determine if cholecalciferol supplementation can reduce BP in patients with ISH.

Vitamin D in ISH (VitDISH), was used to determine the impact of high-dose cholecalciferol upon blood pressure and vascular function in older patients.

Participants who had ISH over 70 years old were randomly assigned either the intervention or placebo in a 1:1 ratio.

The trial medication’s primary outcome was monitored the next day.

Secondary outcome measures included 24-hour blood pressure, markers of cardiovascular risk, and endothelial functions.

Research showed no significant difference between the treatment and placebo groups in systolic pressure.

The systolic blood Pressure in the treatment group decreased by 2.7mm Hg, compared to 14.9mm Hg for the placebo group.

This study is consistent with other findings that Vitamin D supplementation does not reduce blood pressure.

The ROX coupler (4) is another option for interventional therapy to lower blood pressure in elderly patients suffering from ISH.

This innovative treatment for hypertension was chosen due to the rise in cases of treatment-resistant hypertension, despite safe hypertensive drugs (5).

This research article examined the effects of ROX coupler implantation on patients with ISH and patients with combined hypertension (CH). Patients with CH have a higher blood pressure after renal denervation.

Participants with hypertension resistant to treatment were enrolled in a randomized controlled ROX hypertension trial.

There was no difference between CH and ISH in the baseline office systolic BP or ambulatory systolic BP values in participants.

ROX coupler resulted in a reduction of both values (4).

Contrary to previous research, ROX coupler has the same effect on patients with CH and ISH.

Other articles on the treatment of ISH in the elderly showed the importance of antihypertensive drugs in stepped doses in order to reduce risk and prevent complications.

The role of antihypertensive drugs in the treatment of ISH has been crucial. ISH can be a risk factor for developing cardiovascular disease from stiffening of the arteries.

The role of four major antihypertensive therapies (perindopril bendrofluazide and atenolol) is unclear. A randomized controlled trial was conducted with untreated patients with systolic hightension to examine the effects of these drugs on blood pressure and arterial stiffness.

After two weeks of active therapy with the drugs and placebo therapy, it was discovered that central PP was reduced only by bendrofluazide and perindopril. It did not reduce atenolol.

The four drugs showed a similar decrease in peripheral systolic PP and PP, although central pressure and the augmentation index varied.

These variations should influence the choice of therapy.

Advantages and disadvantages

Reviewing the articles on therapeutic options to reduce BP in elderly patients suffering from ISH reveals many strengths and weaknesses.

The researcher clearly justified a modest decrease in systolic BP when intervention was made to treat ISH with cholecalciferol (3).

This result is consistent with another systematic review of Vitamin D supplementation’s effect on blood pressure. It was shown that Vitamin D supplementation is not effective in lowering BP, and that very few people respond to treatment (7).

Participants did not experience any adverse reactions or complications while assessing the effectiveness of Vitamin D supplementation.

High doses were associated with an increase in falls.

This article has some strength in that it included participants with a wide range of comorbidities and medications used. These were compared with real-world issues in these patients.

The intervention helped maintain the 250 HD level (3).

Vitamin D supplementation can reduce the risk of developing cardiac disease in elderly people, but cannot prevent strokes in patients (8).

An analysis of the research article revealed several flaws.

First, the study was not generalizable as only patients of white ethnicity were included in the study.

High doses of Vitamin D, which are essential to maintain serum 250 HD levels, might have adversely affected the results (9).

The clinical relevance of the study is limited for each patient because the sample size was small.

Arteriovenous anastomosis is a useful intervention to lower blood pressure. This is because they can address problems such as recurrences of symptoms, despite the use of medication and compliance.

ROX arteriovenous coupler aids in continual reduction of BP. It adds a low-resistance venous segment to central arterial tree.

This coupler was found to be effective in reducing BP in patients with uncontrolled hypertension (9).

The research article on ROX coupler’s effect on lowering BP in elderly patients with ISH was well-researched. However, it is important to compare BP reductions in patients who have ROX couplesrs and those without stiffened arteries.

Arteriovenous anastomosis could be a new treatment option for patients with ISH.

There are limitations to the research article, such as the small sample size and insufficient consideration of parameters of arterial stiffness.

Patients with ISH have been advised to consider hypertensive agents as a treatment option.

Due to the recent revisions to hypertension treatment guidelines, we need to examine the effects of different classes of antihypertensive drug on high-risk populations (11).

The article on the comparison of the antihypertensive effects on ISH patients has been updated due to the revision in the treatment guidelines.

These results showed that different drug classes can have different outcomes, and patients with increased aortic calcium may need destiffening therapies in order to speed their recovery.

Research articles have limitations. Patients can only see changes in pulse velocity after taking antihypertensive drugs for many years. Therefore, reliable data cannot be generated.

The article’s validity is further reduced by time constraints and the absence of confounding variables (12).

Discussion

Critical analysis of three articles on possible interventions for ISH patients shows the benefits and drawbacks of each intervention when it comes to promoting patient recovery.

This section describes the next steps to consolidate the findings by identifying areas that will further enhance the treatment options.

The first article explains the effects of certain interventions on the treatment process. There is no need to continue research or randomized controlled trials in ISH patients. This study clearly demonstrates the moderate results of Vitamin D supplementation.

Similar results are also found in other research articles (3).

Non-blood pressure effects may increase the effectiveness of Vitamin D supplementation. Future research could be done in this area to promote heart health in the elderly (14).

This research has the advantage of reducing the use of high doses of intermittent cholecalciferol for older patients with ISH (3).

It is clear that the arteriovenous anastomosis works because it lowers both office and arterial blood pressures in ISH and CH (3).

Biophysically, the anastomosis also has a benefit in that it restores arterial compliance. This is a characteristic that tends to shift as we age and ISH.

ISH treatment is difficult because there is no evidence-based guidance.

Patients are at risk from Antihypertensive medications because it is affected by arterial stiffness and vascular age.

Arteriovenous anastomosis may be a new treatment option for patients suffering from ISH (15).

Third article on antihypertensive drugs in ISH. It was found that all four classes of drugs were effective in reducing blood pressure. However, atenolol had a detrimental effect on PP amplification compared with other drugs (5).

The research articles suggest that clinicians should examine the effects of different antihypertensive drugs on central and brachial pressure in order to improve patient outcomes (16).

The researcher emphasized the urgent need to reduce arterial stiffness and analyze the factors that influence the cardiovascular outcomes of patients.

Conclusion

This article reviewed the various therapeutic options for lowering blood pressure in elderly patients suffering from ISH.

Three articles provide an analysis of the strengths and weaknesses of each intervention to reduce the risk and morbidity associated with ISH.

The arteriovenous anastomosis, which is associated with minimal complications and anomalies in the results, was deemed the most beneficial intervention of antihypertensive agents.

Vitamin D supplementation does not provide sustained relief from ISH. Anti-hypertensive medication have different effects for different classes of drugs.

After addressing any limitations in future research, an alternative intervention such as the arteriovenous anastomosis may be an option.

Refer to

Guidelines: Focus on isolated hypertension in young people.

Tsimploulis, A, Sheriff HM. Lam PH., Dooley DJ. Anker MS. Papademetriou V. Fletcher RD. Faselis C. Fonarow GC. Deedwania P. White M. Systolic and diastolic hypertension versus isolated systolichypertension in older adults: Insights From the Cardiovascular Health Study.

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The VitDISH randomized controlled trial of Cholecalciferol to lower blood pressure in patients with isolated hypertension.

JAMA Internal Medicine.

2013 Oct 14th;173(18),:1672-9.

Comparison of Combined Hypertension and Isolated Systolic Hypertension: Effect of Arteriovenous Anastomosis upon Blood Pressure Reduction

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A randomised dose-response investigation of the effects vitamin D3 supplementation has on serum total 25 [OH] D levels and physical performance.

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Stacey D. Legare F. Col NF. Bennett CL. Barry MJ. Eden KB. Holmes?Rovner M. Llewellyn??Thomas H. Decision aids to help people who are facing screening or treatment decisions.

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Tzong KY. Thanataveerat AA. Moran AE. Odden MC. Thanataveerat AB. Tzong KY. Rasmussen PW. Guzman D. Williams L. Bibbins Domingo K. Coxson PG. Goldman L. Cost-effectiveness in hypertension treatment according to 2014 guidelines.

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