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ACCF/AHA 2011 Expert Consensus Document on Hypertension in The ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents, American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association ofBlack Cardiologists, European Society of Hypertension, Wilbert S. Aronow, Jerome L. Fleg, Carl J. Pepine, Nancy T. Artinian, George Bakris, Alan S. Brown, Keith C. Ferdinand, Mary Ann Forciea, William H. Frishman, Cheryl Jaigobin, John B. Kostis, Giuseppi Mancia, Suzanne Oparil, Eduardo Ortiz, Efrain Reisin, Michael W. Rich, Douglas D. Schocken, Michael A. Weber, and Deborah J. Wesley J. Am. Coll. Cardiol. published online Apr 25, 2011; doi:10.1016/j.jacc.2011.01.008 This information is current as of April 25, 2011 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://content.onlinejacc.org/cgi/content/full/j.jacc.2011.01.008v1 Downloaded from content.onlinejacc.org by on April 25, 2011 Journal of the American College of Cardiology Vol. 57, No. 20, 2011 © 2011 by the American College of Cardiology Foundation and the American Heart Association, Inc. ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2011.01.008 EXPERT CONSENSUS DOCUMENT ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents Developed in Collaboration With the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension Writing Wilbert S. Aronow, MD, FACC, Co-Chair* Eduardo Ortiz, MD, MPH† Committee Jerome L. Fleg, MD, FACC, Co-Chair† Efrain Reisin, MD, FASN** Members Carl J. Pepine, MD, MACC, Co-Chair* Michael W. Rich, MD, FACC†† Douglas D. Schocken, MD, FACC, FAHA‡‡ Nancy T. Artinian, PHD, RN, FAHA‡ Michael A. Weber, MD, FACC§§ ʈʈ George Bakris, MD, FASN Deborah J. Wesley, RN, BSN Alan S. Brown, MD, FACC, FAHA‡ *American College of Cardiology Foundation Representative; †Na- Keith C. Ferdinand, MD, FACC§ tional Heart, Lung, and Blood Institute; ‡American Heart Association ʈ Representative; §Association of Black Cardiologists Representative; Mary Ann Forciea, MD, FACP ʈAmerican College of Physicians Representative; ¶American Academy William H. Frishman, MD, FACC* of Neurology Representative; #European Society of Hypertension Representative; **American Society of Nephrology Representative; Cheryl Jaigobin, MD¶ ††American Geriatrics Society Representative; ‡‡American Society for Preventive Cardiology Representative; §§American Society of Hyper- John B. Kostis, MD, FACC tension Representative; ʈʈACCF Task Force on Clinical Expert Con- Giuseppi Mancia, MD# sensus Documents Representative. Authors with no symbol by their name were included to provide additional content expertise apart from Suzanne Oparil, MD, FACC organizational representation. ACCF Task Robert A. Harrington, MD, FACC, Chair Michael F. Gilson, MD, FACC Force Members Mark A. Hlatky, MD, FACC, FAHA Eric R. Bates, MD, FACC Alice K. Jacobs, MD, FACC, FAHA Deepak L. Bhatt, MD, MPH, FACC, FAHA Sanjay Kaul, MBBS, FACC Charles R. Bridges, MD, MPH, FACC¶¶ David J. Moliterno, MD, FACC Mark J. Eisenberg, MD, MPH, FACC, Debabrata Mukherjee, MD, FACC¶¶ FAHA¶¶ Robert S. Rosenson, MD, FACC, FAHA¶¶ Victor A. Ferrari, MD, FACC, FAHA James H. Stein, MD, FACC¶¶ John D. Fisher, MD, FACC Howard H. Weitz, MD, FACC Timothy J. Gardner, MD, FACC, FAHA Deborah J. Wesley, RN, BSN Federico Gentile, MD, FACC ¶¶Former Task Force member during this writing effort. This document was approved by the American College of Cardiology Foundation Board Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ. of Trustees and the American Heart Association Science Advisory and Coordinating ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a Committee in October 2010 and the governing bodies of the American Academy of report of the American College of Cardiology Foundation Task Force on Clinical Neurology, American Geriatrics Society, American Society for Preventive Cardiology, Expert Consensus Documents. J Am Coll Cardiol 2011;57:xxx–xx. American Society of Hypertension, American Society of Nephrology, Association of This article has been copublished in Circulation, the Journal of the American Society Black Cardiologists, and European Society of Hypertension in March 2011. For the of Hypertension, the Journal of Clinical Hypertension, and the Journal of Geriatric purpose of complete transparency, disclosure information for the ACCF Board of Cardiology. Trustees, the board of the convening organization of this document, is available at: http:// Copies: This document is available on the World Wide Web sites of the American www.cardiosource.org/ACC/About-ACC/Leadership/Officers-and-Trustees.aspx. College of Cardiology (www.cardiosource.org), the American Heart Association ACCF board members with relevant relationships with industry to the document may (my.americanheart.org). For copies of this document, please contact Elsevier Inc. review and comment on the document but may not vote on approval. Reprint Department, fax 212-633-3820, e-mail [email protected]. The American College of Cardiology Foundation requests that this document be Permissions: Modification, alteration, enhancement, and/or distribution of this cited as follows: Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, document are not permitted without the express permission of the American College Ferdinand KC, Forciea MA, Frishman WH, Jaigobin C, Kostis JB, Mancia G, of Cardiology Foundation. Downloaded from content.onlinejacc.org by on April 25, 2011 2 Aronow et al. JACC Vol. 57, No. 20, 2011 Hypertension in the Elderly May 17, 2011:000–00 1.6.2. Coronary Artery Disease.......................xxxx TABLE OF CONTENTS 1.6.3. Disorders of Left Ventricular Function ........xxxx 1.6.3.1. HEART FAILURE ...........................xxxx Preamble .....................................................xxxx 1.6.3.2. LEFT VENTRICULAR HYPERTROPHY.............xxxx 1.6.4. Atrial Fibrillation ..............................xxxx Executive Summary ........................................xxxx 1.6.5. Abdominal Aortic Aneurysm and Peripheral Arterial Disease.....................xxxx 1.6.5.1. ABDOMINAL AORTIC ANEURYSM ..............xxxx 1. Introduction ..............................................xxxx 1.6.5.2. THORACIC AORTIC DISEASE ..................xxxx 1.6.5.3. PERIPHERAL ARTERIAL DISEASE ..............xxxx 1.1. Document Development Process and 1.6.6. Chronic Kidney Disease .......................xxxx Methodology ........................................xxxx 1.6.7. Ophthalmologic Impairment...................xxxx 1.1.1. Writing Committee Organization .............xxxx 1.6.7.1. AGE-ASSOCIATED RETINAL CHANGES ...........xxxx 1.1.2. Relationships With Industry and Other Entities....xxxx 1.6.7.2. PATHOPHYSIOLOGY ........................xxxx 1.1.3. Consensus Development .......................xxxx 1.6.8. Quality of Life Issues ..........................xxxx 1.1.4. External Peer Review ..........................xxxx 1.1.5. Final Writing Committee and Task Force 2. Interactions Between Aging and Other CV Risk Approval of the Document ....................xxxx Conditions Associated With Hypertension .........xxxx 1.1.6. Document Approval ...........................xxxx 1.1.7. Document Methodology .......................xxxx 2.1. Family History of Premature Coronary Artery Disease 1.2. Purpose of This Expert Consensus Document ....xxxx ..............................................xxxx 2.2. Dyslipidemia 1.3. General Considerations............................xxxx ........................................xxxx 1.4. Nomenclature, Definitions, and 2.3. Diabetes Mellitus ..................................xxxx Clinical Diagnosis ..................................xxxx 2.4. Obesity and Weight Issues ........................xxxx 1.5. Magnitude and Scope of the Problem ...........xxxx 2.4.1. Structural and Hemodynamic Changes ........xxxx 1.5.1. Epidemiology of Hypertension Related 2.4.2. Vascular Changes ..............................xxxx to Aging .......................................xxxx 2.4.3. Role of the Sympathetic Nervous System ......xxxx 1.5.1.1. ISOLATED SYSTOLIC HYPERTENSION ...........xxxx 2.4.4. Role of the Renin-Angiotensin-Aldosterone 1.5.1.2. SYSTOLIC AND DIASTOLIC HYPERTENSION AND System .........................................xxxx PULSE PRESSURE..........................xxxx 2.5. Microalbuminuria ...................................xxxx 1.5.1.3. SPECIAL POPULATIONS......................xxxx 2.6. Hyperhomocysteinemia ............................xxxx 1.5.1.3.1. ELDERLY WOMEN ................xxxx 1.5.1.3.2. ELDERLY BLACKS ................xxxx 2.7. Gout..................................................xxxx 1.5.1.3.3. ELDERLY HISPANICS ..............xxxx 2.8. Osteoarthritis and Rheumatoid Arthritis.........xxxx 1.5.1.3.4. ELDERLY ASIANS.................xxxx 1.5.2. Pathophysiology of Hypertension in the 3. Clinical Assessment and Diagnosis..................xxxx Elderly.........................................xxxx 1.5.2.1. AORTA AND LARGE ARTERIES ................xxxx 3.1. Measurement of Blood Pressure .................xxxx 1.5.2.2.
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