The Camerano study on hypertension: the problem of arterial hypertension in the elderly

Epidemiological aspects of isolated systolic hypertension in the elderly population as cerebrovascular risk factor

A large number of studies indicate that isolated systolic hypertension (ISH) is an important cerebrovascular risk factor. This clinical state is very common in elderly people who are the most exposed to stroke risk. Therefore, it is important to know the real prevalence of ISH, in order to predict the possible incidence of cerebrovascular disease in the elderly population. In the Camerano study on hypertension, we have verified the prevalence of ISH in the elderly. ISH has been considered clinically when the systolic arterial pressure (SAP) was higher than 160 mmHg, and the diastolic arterial pressure (DAP) was lower than 90 mmHg. In our study population, an ISH prevalence of 11.9% was found in the elderly (above 60 years of age); whereas in the adult population (between 30 and 60 years), it amounted only to 4.5%.

Random fasting hyperglycemia as cardiovascular risk factor in the elderly: a 6-year longitudinal study

A large body of evidence suggests that diabetes increases the risk of coronary heart disease (CHD), but whether fasting hyperglycemia is associated with a major risk for CHD is still under debate. The aim of the present study was to investigate the role played by fasting hyperglycemia in the development of cardiovascular disease (CVD) in an elderly population when associated with common risk factors for CVD (i.e., hypertension, hypercholesterolemia, smoking, etc). We analyzed a sample of 455 subjects aged > or = 60 years. The risk factors taken into account were systolic and diastolic blood pressure levels, use of antihypertensive drugs, total serum cholesterol, serum triglycerides, and smoking habit. Glycemia was measured at entry on a fasting sample. During the follow-up period (mean 6 years), the occurrence of CVD was monitored (criteria for the occurrence of CVD included total cardiovascular mortality, fatal or nonfatal myocardial infarction, symptomatic coronary heart disease [stable and unstable angina], the need for percutaneous transluminal coronary angioplasty or coronary artery bypass graft, fatal or nonfatal stroke, and transient ischemic attack). A total of 427 subjects completed the follow-up. During this period, 73 subjects (17.10%) developed CVD according to the above criteria. A Cox proportional hazard model was designed to evaluate the contribution of variables in predicting CVD. Relative risks and 95% confidence intervals for CVD were calculated from the regression coefficients to study the association between the risk of developing CVD and predicting variables. We found a relation between occurrence of CVD and fasting hyperglycemia: subjects with fasting glycemia, > 126 mg/dl at enrollment, but without previous clinical diagnosis of diabetes, showed a 2.01 times higher risk than those with fasting glycemia < 126 mg/dl. Hence, random fasting hyperglycemia can predict the occurrence of CVD in elderly subjects.

Sexual dimorphism in arterial hypertension: an age-related phenomenon

Epidemiological, clinical and experimental evidence is available indicating that male subjects develop hypertension with a higher probability than age-matched females. The sexual dimorphism of blood pressure (BP) has been observed both in normotensive and hypertensive subjects. In order to analyze the presence of sexual dimorphism of arterial hypertension (AH) and its relationship to the aging process - particularly to the menopause - the population screened in the Camerano Study has been examined. In addition, to evaluate sex-related differences in the AH, another sample of 3765 patients from our Hypertension Centre has also been considered. Our samples displayed a real cross-over in the prevalence of arterial hypertension, hypercolesterolemia, hyperglycemia and obesity in women versus men, after the menopausal period. In fact, in the adult group (20-54 years) the prevalence of arterial hypertension was significantly higher (P<0.005) in males (9.2%) than females (6.4%), whereas in the older group (>54 years), we observed a significantly higher prevalence (P<0.001) in females (46.6%) than in males (34.7%). These results suggest that the menopause and age can play a separate role in the sexual dimorphism of arterial hypertension. A significant gender-related difference in hypertensive patients was found only in hypercholesterolemia above the age of 50 years, namely, females have this disorder more frequently.