Systemic systolic hypertension in the elderly: Correlation of hemodynamics, plasma volume, renin, aldosterone, urinary metanephrines and response to thiazide therapy

doi:10.1016/S0002-9149(86)80033-9

The American Journal of Cardiology

Volume 58, Issue 10, 1 November 1986, Pages 1030-1034

https://doi.org/10.1016/S0002-9149(86)80033-9 Get rights and content

Twenty-four men, mean age 63 ± 1.7 years, with systemic systolic hypertension were studied before and after 1 month of therapy with oral hydrochlorothiazide, 50 mg/day. The control mean plasma volume was 2,664 ± 96 ml, cardiac index 3.9 ± 0.2 liters/min/m², stroke volume index 52 ± 2 ml/beat/m², systemic vascular resistance 1,351 ± 80 dynes s cm⁻⁵, plasma aldosterone 8.6 ± 1.0 ng/dl and 24-hour urinary excretion of metanephrines 0.371 ± 0.044 mg. On renin-sodium profiling in 23 patients, 12 were classified into a normal group and 11 into a low-renin group; none had high renin values. Based on multiple regression analysis, the 24-hour urinary excretion of total metanephrines appeared to be the single most important factor explaining 28% of the variability in systolic blood pressure (BP). After therapy with oral hydrochlorothiazide, the elevated systolic BP decreased (p <0.0001) and diastolic BP decreased (p <0.005), with concomitant reduction in systemic vascular resistance (p <0.03). Patients in both the normal-and low-renin groups had normal plasma volume and responded similarly to thiazide diuretic therapy, without symptomatic side effects.

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Increased cardiac and vascular morbidity and mortality are known to accompany systemic systolic hypertension of the elderly. We have reported on the hemodynamic benefit in this disorder after 1 month of therapy with a thiazide diuretic, and on the maintenance of improvement for 1 year.¹ In another group of patients with systolic hypertension we have reported on the changes in plasma volume, renin activity, and aldosterone, lipid and urinary metanephrine levels at 1 month of such therapy.² This study extends these observations to 1 year of thiazide therapy and explores the relation between the hemodynamic and biochemical variables during this period.
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^*: This study was supported by the Veterans Administration and by grant RR-229 from the Division of Research Resources, National Institutes of Health, Bethesda, Maryland.

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Systemic systolic hypertension in the elderly: Correlation of hemodynamics, plasma volume, renin, aldosterone, urinary metanephrines and response to thiazide therapy*

Am J Cardiol

Am J Cardiol

JACC

Am J Med

Am J Cardiol

Am J Med

Am J Cardiol

Am J Cardiol

Kidney Int

Perspective of systolic hypertension: the Framingham study

Circulation

Systolic hypertension in the elderly: hemodynamic response to long-term thiazide diuretic therapy and its side effects

JAMA

Borderline hypertension: relationship between age, hemodynamics and circulating catecholamines

Circulation

Influence of the sympathetic nervous system on aortic compliance

Clin Sci

Volume Studies. II. Simultaneous determination of plasma volume, red cell mass, extracellular fluid and total body water before and after volume expansion in dog and man

J Lab Clin Med

‘Pipe-stem’ brachial arteries: a cause of pseudohypertension

JAMA