Systolic hypertension in the elderly. Hemodynamic response to long-term thiazide diuretic therapy and its side effects
S. Vardan, S. Mookherjee, R. Warner and H. Smulyan
Twenty-three patients older than 50 years, with systolic hypertension,
underwent hemodynamic study. Cardiac output and stroke volume varied
widely, with several high values. An elevated systemic vascular resistance,
when considered as a function of the cardiac output, was the most prevalent
hemodynamic abnormality. After administration of hydrochlorothiazide, 50
mg/day, for one month in 20 patients, 18 had a significant fall in BP,
systemic vascular resistance, and stroke volume. After one year of
continuous therapy, the hemodynamics, studied in 14 patients, did not
change further. There were no clinical difficulties with carbohydrate
intolerance, azotemia, hyperuricemia, or hypokalemia. No patient had
symptoms of orthostatic hypotension or cardiac arrhythmias. Thus, thiazide
therapy effectively and safely lowers the BP in most patients with systolic
hypertension by reducing systemic vascular resistance.
