By L. Michael Prisant

A complete overview of all elements of high blood pressure within the aged utilizing the most up-tp-date medical facts. issues variety from simple innovations, epidemiology and trials, and assessment and administration, to pharmacologic remedy, targeted populations, and adherence, all offered 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 carried out in older folks, in addition to the issues of medical overview, secondary high blood pressure, adherence, and aim organ harm. broad discussions of pharmacologic treatment aspect the function of the entire significant drug sessions.

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This reduction is thought to be mainly the result of an increase in oxidative stress during aging. Presumably, superoxide anion quenches endothelium-derived NO through a chemical reaction to form peroxynitrite (5,15,22). Thus, vasoconstriction is promoted because the dilator activity of NO is removed. However, this is not the only mechanism by which superoxide acts because it is known to cause contraction of vascular smooth muscle in the absence of the endothelium or in the presence of inhibitors of nitric oxide synthase.

Age-related physiological changes, such as decreased renal, hepatic, and cardiac function, generally produce more clinically significant alterations in drug disposition than plasma protein binding. Drug Metabolism PHYSIOLOGICAL CHANGES INFLUENCING HEPATIC METABOLISM Aging is accompanied by marked changes in the physiology of many organs, as well as in the functions of their constituent cells. These nonpathological alterations in structure or function may affect normal physiological processes in the elderly as relates to drug disposition.

Asai K, Kudej RK, Shen YT, et al. Peripheral vascular endothelial dysfunction and apoptosis in old monkeys. Arterioscler Thromb Vasc Biol 2000;20:1493–1499. 19. Challah M, Nadaud S, Philippe M, et al. Circulating and cellular markers of endothelial dysfunction with aging in rats. Am J Physiol 1997;273 (4Pt 2):H1941–H1948. 20. Cernadas MR, Sanchez de Miguel L, Garcia-Duran M, et al. Expression of constitutive and inducible nitric oxide synthases in the vascular wall of young and aging rats. Circ Res 1998;83:279–286.

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