Systolic hypertension in the elderly. Hemodynamic response to long-term thiazide diuretic therapy and its side effects

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Abstract
Twenty-three patients older than 50 yr, 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 1 mo. in 20 patients, 18 had a significant fall in BP [blood pressure], systemic vascular resistance and stroke volume. After 1 yr 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. Thiazide therapy effectively and safely lowers the BP in most patients with systolic hypertension by reducing systemic vascular resistance.