By L. Michael Prisant

A accomplished overview of all points of high blood pressure within the aged utilizing the most up-tp-date medical information. issues diversity from easy recommendations, epidemiology and trials, and overview and administration, to pharmacologic therapy, precise populations, and adherence, all provided with an emphasis at the optimum administration of sufferers. The authors learn intimately the mechanisms of high blood pressure within the aged, the approach to life trials and results trials that have been performed in older individuals, in addition to the issues of scientific evaluate, secondary high blood pressure, adherence, and goal organ harm. huge discussions of pharmacologic remedy element the position of all of the significant drug sessions.

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Fliser D, Ritz E. Relationship between hypertension and renal function and its therapeutic implications in the elderly. Gerontology 1998;44:123–131. 34. Hill GS, Heudes D, Bariety J. Morphometric study of arterioles and glomeruli in the aging kidney suggests focal loss of autoregulation. Kidney Int 2003;63:1027–1036. 35. Muhlberg W, Platt D. Age-dependent changes of the kidneys: pharmacological implications. Gerontology 1999;45:243–253. 36. Ruilope LM. Prevalence of renal disease in elderly hypertensive patients with cardiovascular problems.

The pulsatile or dynamic component of blood pressure is the summation of three major factors: cardiac contractility (stroke volume), aortic impedance (central arterial stiffness), and late systolic pressure augmentation caused by pulse wave reflection from the distal circulation (Fig. 2). Central Arterial Stiffness Large central arteries, predominantly the thoracic aorta and its proximal branches, fulfill the damping function by expanding during systole, storing some but not all of each stroke volume, and utilizing elastic recoil to propel the residual of each stroke volume to the periphery during diastole.

Several cardiovascular medications have been considered regarding their ability to increase regional intestinal blood flow, with inconclusive findings. These studies have generally been carried out under acute conditions and cannot be generalized to the usual circumstances of cardiovascular medication administration in the elderly (7,8). Transdermal Absorption The barrier function characteristics of human skin change dramatically with increasing age (9). Any pharmacological penetrant has three potential pathways to the underlying viable tissue: through hair follicles with associated sebaceous glands, via sweat ducts, or across continuous stratum corneum between these appendages.

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