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Titolo:
The diastolic blood pressure in systolic hypertension
Autore:
Smulyan, H; Safar, ME;
Indirizzi:
SUNY Hlth Sci Ctr, Syracuse, NY 13210 USA SUNY Hlth Sci Ctr Syracuse NY USA 13210 h Sci Ctr, Syracuse, NY 13210 USA Hop Broussais, F-75674 Paris, France Hop Broussais Paris France F-75674Hop Broussais, F-75674 Paris, France
Titolo Testata:
ANNALS OF INTERNAL MEDICINE
fascicolo: 3, volume: 132, anno: 2000,
pagine: 233 - 237
SICI:
0003-4819(20000201)132:3<233:TDBPIS>2.0.ZU;2-A
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY HEART-DISEASE; MYOCARDIAL-INFARCTION; HUMAN AORTA; CARDIOVASCULAR MORTALITY; PULSE PRESSURE; PREDICTOR; STROKE;
Tipo documento:
Editorial Material
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
39
Recensione:
Indirizzi per estratti:
Indirizzo: Smulyan, H SUNY Hlth Sci Ctr, 750 E Adams St, Syracuse, NY 13210 USA SUNY Hlth Sci Ctr 750 E Adams St Syracuse NY USA 13210 3210 USA
Citazione:
H. Smulyan e M.E. Safar, "The diastolic blood pressure in systolic hypertension", ANN INT MED, 132(3), 2000, pp. 233-237

Abstract

Because antihypertensive therapy is effective in elderly patients with isolated systolic hypertension, attention has been focused on the systolic blood pressure as a predictor of cardiovascular risk. However, it is a normal diastolic pressure that separates patients with isolated systolic hypertension from those with essential hypertension. The normal diastolic and elevated systolic pressures are largely due to age-related stiffening of the aorta, An indistensible aorta causes the pressure pulse to travel faster than normal, where it is quickly reflected off the peripheral resistance. The reflected wave then returns to the centra I aorta in systole rather than diastole. This augments the systolic pressure further, increasing cardiac work while reducing the diastolic pressure, on which coronary flow is dependent. The potential harm of further reducing the diastolic pressure with antihypertensive therapy, especially in patients with coronary heart disease, underlies the controversial "J curve. " By decreasing the blood pressure, all antihypertensive agents improve aortic distensibility, but no agents do so directly; the nitrates come the closest. Such an agent would be useful becauseany therapeutic increase in aortic distensibility would decrease systolic pressure without greatly reducing diastolic pressure. The problem is complicated by the suspected inaccuracy of the cuff technique in predicting the aortic diastolic pressure. New noninvasive methods to predict the aortic diastolic pressure may help in the future. At present, the combination of a high systolic and normal diastolic pressure-a widened pulse pressure-seems tobe the best predictor of cardiovascular risk in patients with hypertensionor heart disease. Patients with isolated systolic hypertension should be treated, but marked diastolic hypotension should be avoided.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 28/03/20 alle ore 13:52:39