A Cross-sectional Investigation on Essential Hypertension in the Elderly of Jinan and a Prospective Study on Antihypertension Treatment in the Very Elderly with Essential Hypertension
|School||Shandong Provincial Academy of Medical Sciences|
|Keywords||elderly hypertension morbidity mortality rate of treatment rate of control cardiovascular disease stroke ambulatory blood pressure ultrasonic cardiogram risk factor perindopril indapamide|
Background:Essential hypertension is the most common cardiovascular disease in the elderly and one of the main risk factor caused stroke,coronary heart disease,diabetes,chronic renal disease, heart or renal failure, death and disable.Age is also one risk factor of cardiovascular disease. The elderly with essential hypertension is in high risk. They often have many risk factor of cardiovascular disease and target organ impairment. The epidemiologic researchs show that the 2/3 elderly aged over 65 have essential hypertension. There were many trails that showed antihypertension treatment was benefit to the hypertensives aged under 80 years, such as EWPHE(1985),Syst-China(1998),etc. But there is no conclusion about whether or not the benefits of treating hypertension in individuals older than 80 years was the same as that of doing in the younger hypertensives.Objective:1. To investigate the current prevelence of essential hypertension in the elderly aged over 60 of Jinan.2. To explore the effect of age on ambulatory blood pressure (ABP) in very elderly hypertensive patients. 3. To investigate the correlationship between essential hypertension and target organ damage in the very elderly.4. To explore the effect of anti-hypertension on 24-hour ambulatory blood pressure rhythm in the very elderly hypertensives.5. To explore the effect of anti-hypertension on target-organ damage in very elderly hypertensives.6. To explore the impact of anti-hypertension treatment on total mortality and the mortality and morbidity of stroke and cardiovascular disease in the very elderly hypertensives.Methods:1. 2178 subjects aged over 60 were involved and were examined. Datas from 2178 subjects were analyzed for explore the current prevelence of essential hypertension in the elderly aged over 60 of Jinan.2. 300 hypertensives aged over 80 were enrolled in this study.We analyzed the effect of anti-hypertension theropy in the very elderly patients on total mortality and the mortality and morbidity of stroke and cardiovascular disease in the very elderly hypertensives.Results:1. The prevalence of hypertension, the treatment rate, the control rate was respectively 57.5%, 55.7% and 16.8% in the elderly of Jinan. The prevalence of essential hypertension and ISH increased along with the age(P<0.05). The patient aged over 60 with ISH is count 59.1% of the elder hypertensives. The number of female with ISH is more than that of male(P<0.05).2. The ratio of the elder patient with having many other risk factors of cardiovascular disease is higher than that of the elderly with normal blood pressure(P <0.01). 3. The elder hypertensives in Jinan have diuretic, CCB and compound preparation.4. Blood pressure of the very elder hypertensives were characterisd by isolated systolic hypertension and pulse pressure is becoming high with age increasing.5. The number of the very elder hypertensives of concentric hypertrophy of heart is the most. LVMI significantly increases in groups of concentric hypertrophy and eccentric hypertrophy. Both E/A of the group of concentric hypertrophy and EF of the group of eccentric hypertrophy significantly decrease. The difference of Tei index of all groups is not significant.6. The results of multiple stepwise regression analysis showed: LVMI=23.120+2.001×24hSBPSD+73.481×dSBPLO , RWT=0.54-0.00176×24hPP, Tei=0.0469+0.03205×dSBP. The results of logistic regression analysis showed that left ventricular hypertrophy is correlated to 24h SBP.The regression equation acquired is P=Exp(-22.934+0.14924hSBP)/〔1+Exp(-22.934+0.14924hSBP)〕.7. The difference of mortality of A, B, C AND D groups is very significant.So are the mortality and morbidity of stroke and cardiovascular disease.8. The risk for death is correlated to diabetes, LDL-C increasing, TG increasing and smoking. The risk coefficient is 1.436, 1.408, 0.935 and 0.845 respectively.9. The analysis by cox w/time-dep cov showed that the risk for death is correlated to nDBP, dHR, EF, Tei index and LVMI significantly.Consults:1. Essential hypertension is the most common cardiovascular disease in the elderly of Jinan. The morbidity of essential hypertension increases along with age. The prevalence of essential hypertension in the rural of Jinan increases quickly. The morbidity of the rural has no difference with that of the urban in Jinan.2. The morbidity of femal and male have no difference in Jinan. But the prevalence of ISH in femal is higher.3. The rate of treatment and control is very low in Jinan. ISH is the main type of essential hypertension in the elderly of Jinan.4. The ratio of patients having several risk factors of cardiovascular diseases is very high in the elderly of Jinan.5. There are the phenomenona such as innormal treatment, unfit drugs used,et al.6. Blood pressure of the very elder hypertensives were characterisd by isolated systolic hypertension and pulse pressure is becoming high along with age.7. Tei index can evaluate heart function better. The structure and of left ventricular is correlated to all parometers of ABPM.8. Anti-hypertension treatment significantly improves 24-hour ambulatory blood pressure rhythm in very elderly hypertensives. Anti-hypertension treatment may significantly improve left ventricular hypertrophy and renal function damage in the very elderly hypertensives.Anti-hypertension can protect targe organs function and postpone the damage of them in the very elderly hypertensives. Anti-hypertension treatment in the very elderly hypertensives can effectively decrease the total mortality, the mortality and morbidity of stroke and cardiovascular diseases.