Summary
Objectives: Follow-up changes in main hemodynamic variables of the treadmill stress test (heart rate, SBP, DBP) in elderly patients with the diagnosis of isolated systolic hypertension before and after 8 weeks of treatament with Amlodipine tailored towards normalization of SBP.
Methods: 25 patients were selected for placebo run-in (wash-out, 1 week). Age limits were 65 and 90 years-old, EKG sinus rithm, physical fitness as to allow reaching maximal heart rate response without eliciting ischemic patterns, besides predominantly systolic hypertension as background diagonsis (SBP between 160 and 200 mmHg, and DBP below 95 mmHg supine at rest). Treadmill protocols were standardized (modified Bruce Protocol) with HR, SBP,DBP checked every 3 minutes by the same investigate. All patients have received clinical visits every other week when up or downtitration could be offered (5 to 10 mg of Amlodipina) according to indication.
Main variables looked at the follow-up were SBP and DBP at rest during 8 weeks; HR, SBP and DBP (at rest, 3, 6, 9, and 12 minutes of treadmil test ) before and after treatment for patients with controled supine SBP. Controlled BP was defined as SBP of 140 mmHg or less (supine at rest) DBP of 85 mmHg or below; or SBP reduction of at least 10 mmHg by week 8.
Results: Mean age was 74.6 + 4.9 years with 16 (64%) female. Six patients (24%) were excluded, 3 (12%) before receiving medication, and 3 due to loss of follow-up. All other 19 patients experienced BP control (10 patients or 52.6% with 5 mg and 9 or 47.4% with 10 mg).
Mean BP levels at rest before and after treatment: 175.8 x 86.4 mmHg e 139.6 x 77.7 mmHg (p<0.001). Resting HR and body weight did not change during the 8 weeks of study. Left axis shift and/or left heart EKG overload were common findings, whereas 3 patients had branch blocks. None of 12-lead EKGs significantly changed during the study.
The most significant change was the continuous reduction in the double-product (HRXSBP) during the test: -7.8% at 3 minutes (p<0.05), -10.4% at 6 minutes (p<0.01) and -13.5% at 9 minutes (p<0.01). This reduction was due mainly to SBP reduction 3 to 6 minutes, due to both reductions at 9th minute. Only 3 (12%) patients reached the 12-minute landmark before treatment, ande 6 (24%) after Amlodipine. Therefore, Amlodipine was effective in delaying (p<0.05) the time to maximal HR (from 9.2 para 10.1 minutes or 9.8% increase) whereas improving (p<0.05) ergomectric load (from 41.6 to 46.4 mph% or 11.5% increase). Two patients (9.1%) reported ankle edema with 10 mg Amlodipine without discontinuation.
Conclusions: Authors conclude that isolated systolic hypertension in the elderly is well controlled by Amlodipine in dosages commonly used for essential hypertension. They also emphasize the ergomectric gain of this control not fully explained by the BP effect. The postponement of the HRmax landmark is of a significant role into this context. Tolerability of Amlodipine was within reported figures.
Desenvolvido por Node1 Interactive – 2001