Elderly Hypertensive Individuals Research Articles

Pathways to usage intention of mobile health apps among hypertensive patients: A fuzzy-set qualitative comparative analysis.

Background: The efficacy of mHealth apps in managing hypertension has been proven; however, low usage intention remains a significant challenge, warranting an in-depth exploration of the influencing factors. Objectives: This study aimed to examine the factors influencing hypertensive new users' intention to use mobile health applications through a cross-sectional survey. Methods: Fuzzy-set qualitative comparative analysis (fsQCA) was employed to investigate the combinations of various determinants, including technology acceptance, adoption factors, compliance behavior initiation factors, and time motivation factors for decision making. Results: A total of 100 middle-aged and elderly hypertensive individuals participated in the survey, with 98 responses included in the final statistical analysis. The analysis identified four distinct configurations that contribute to high usage intentions, with solution consistency and coverage values of 0.93 and 0.36, respectively. Conclusion: The findings suggest that intervention strategies should account for the various pathways leading to usage intentions.

A prediction study on the occurrence risk of heart disease in older hypertensive patients based on machine learning

ObjectiveConstructing a predictive model for the occurrence of heart disease in elderly hypertensive individuals, aiming to provide early risk identification.MethodsA total of 934 participants aged 60 and above from the China Health and Retirement Longitudinal Study with a 7-year follow-up (2011–2018) were included. Machine learning methods (logistic regression, XGBoost, DNN) were employed to build a model predicting heart disease risk in hypertensive patients. Model performance was comprehensively assessed using discrimination, calibration, and clinical decision curves.ResultsAfter a 7-year follow-up of 934 older hypertensive patients, 243 individuals (26.03%) developed heart disease. Older hypertensive patients with baseline comorbid dyslipidemia, chronic pulmonary diseases, arthritis or rheumatic diseases faced a higher risk of future heart disease. Feature selection significantly improved predictive performance compared to the original variable set. The ROC-AUC for logistic regression, XGBoost, and DNN were 0.60 (95% CI: 0.53–0.68), 0.64 (95% CI: 0.57–0.71), and 0.67 (95% CI: 0.60–0.73), respectively, with logistic regression achieving optimal calibration. XGBoost demonstrated the most noticeable clinical benefit as the threshold increased.ConclusionMachine learning effectively identifies the risk of heart disease in older hypertensive patients based on data from the CHARLS cohort. The results suggest that older hypertensive patients with comorbid dyslipidemia, chronic pulmonary diseases, and arthritis or rheumatic diseases have a higher risk of developing heart disease. This information could facilitate early risk identification for future heart disease in older hypertensive patients.

Gender disparities in physical, psychological, and cognitive multimorbidity among elderly hypertensive populations in rural regions

BackgroundThe prevalence of gender disparities in physical, mental, and cognitive disorders among elderly hypertensive individuals in rural areas remains unclear. This study evaluates these disparities and the factors contributing to multimorbidity in this demographic.MethodsA face-to-face survey was conducted from July 1 to August 31, 2023, involving the hypertensive population registered with the National Basic Public Health Service Program in Jia County. Physical disorder was defined as having one or more self-reported chronic conditions other than hypertension. Participants experiencing anxiety or depression were as having a psychological disorder. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess depression symptomatology, and anxiety symptoms were evaluated using the 7-item Generalized Anxiety Disorder questionnaire (GAD-7). Cognitive disorders were assessed using the Brief Mental Status Examination Scale (MMSE). Multifactorial logistic regression models were used to analyze factors affecting different disorder combinations in both genders. The net difference in multimorbidity prevalence between genders was determined using the propensity score matching (PSM).ResultsOut of 18,447 hypertensive individuals aged 65 years and above (42.28% men), the prevalence of multimorbidity was 30.64% in men and 38.67% in women. Outcomes included seven categories: physical disorders, psychological disorders, cognitive disorders, and four different combinations of these disorders. The primary outcome was the presence of two or more disorders. The prevalence of physical, psychological, and cognitive disorders and their four combinations were higher in women than in men; Key factors influencing multimorbidity risk included subjective health status, illness duration, medication history, blood pressure control, and lifestyle behaviors in both men and women. Post-PSM analysis revealed that women had a 6.74% higher multimorbidity prevalence than men.ConclusionsPhysical, psychological, and cognitive disorders, along with their various multimorbid combinations, significantly impact the elderly hypertensive population. Prioritizing a healthy lifestyle is essential to mitigate multimorbidity risks. Considering that the prevalence of multimorbidity is higher in women than in men with hypertension, sufficient sleep, maintaining a healthy waist circumference, and medication adherence are vital for managing blood pressure and reducing multimorbidity risks.

Physiological characteristics of blood pressure responses after combined exercise in elderly hypertensive patients: a systematic review and meta-analysis.

The aim of this investigation is to explore the efficacy of combined exercise in elderly patients with hypertension. Moreover, we aim to delve into the underlying mechanisms governing blood pressure regulation, with the objective of promoting the adoption of this exercise regimen among elderly hypertensive individuals. In our study, we conducted a thorough search across multiple databases, including PubMed, Web of Science, Cochrane Library, Embase, and Scopus. This extensive search resulted in the preliminary screening of 2,347 articles. Among these, 9 studies were carefully selected for an in-depth analysis. For our meta-analysis, we employed Review Manager 5.3 and Stata 15.0, enabling us to perform detailed subgroup analyses and assess the possibility of publication bias. In comparison to the control group (n = 194), individuals enrolled in the combined exercise group (n = 200) exhibited a notable decrease in both resting systolic blood pressure (SBP) [weighted mean difference (WMD) = -11.17 mm Hg, 95% confidence interval (CI) (-17.13, -5.22), Z = 3.68, P < 0.05] and diastolic blood pressure (DBP) [WMD = -5.93 mm Hg, 95% CI (-9.24, -2.61), Z = 3.51, P < 0.05]. Nonetheless, no statistically significant alteration was observed in pulse pressure (PP) [WMD = -9.05 mm Hg, 95% CI (-22.65, 4.55), Z = 1.3, P = 0.192]. Further subgroup analyses elucidated that combined exercise regimens, characterized by aerobic training intensities below 85% of HRmax, durations of up to 12 weeks, weekly frequencies of either ≥3 or <3 sessions, total session times under 60 min, and a sequence of aerobic exercise followed by resistance training (AE-RT), were particularly effective in enhancing SBP and DBP among elderly patients with hypertension. Additionally, regular engagement in combined exercise led to significant improvements in SBP and DBP across individuals aged 60-70, those older than 70 years, and regardless of whether participants were using antihypertensive medications or not. Combined exercise serves as an efficacious adjunctive therapy for reducing blood pressure among elderly individuals with hypertension, exerting beneficial influences on multiple physiological mechanisms pertinent to blood pressure regulation. Moreover, the integration of aerobic exercise with resistance training presents a more varied training program, thereby eliciting wider-ranging positive effects on both the physical and mental well-being of elderly patients afflicted with hypertension.

Celery Leaf Consumption Movement (GAME BUSRI): A Community-Based Intervention to Promote Blood Pressure Control in Elderly Individuals with Hypertension in Purwakarta Indonesia

Hypertension, a major risk factor for cardiovascular disease, poses a significant health challenge, particularly among the elderly. The "GAME BUSRI" intervention, promoting celery leaf consumption, offers a promising complementary therapy for blood pressure management. This study aimed to evaluate the effectiveness of this community-based intervention in reducing blood pressure among hypertensive elderly individuals in Purwakarta, Indonesia. A quasi-experimental pretest-posttest control group design was employed. Participants were recruited from the community and assigned to either the intervention group (receiving daily celery leaf decoction and health education) or the control group (receiving health education only). Blood pressure measurements were taken at baseline and after the 8-week intervention period. Data were analyzed using appropriate statistical tests. The intervention group demonstrated a statistically significant reduction in both systolic and diastolic blood pressure compared to the control group. The mean reduction in systolic blood pressure was 11.33 mmHg (p &lt; 0.001), and the mean reduction in diastolic blood pressure was 8.67 mmHg (p &lt; 0.001). No adverse events were reported. The "GAME BUSRI" intervention effectively reduced blood pressure in hypertensive elderly individuals. This community-based approach, utilizing a readily available and culturally acceptable resource, holds promise for improving hypertension management and reducing cardiovascular risk in this population.

Comparable cerebral cortex activity and gait performance in elderly hypertensive and healthy individuals during dual-task walking: A fNIRS study.

Hypertension increases the risk of cognitive impairment and related dementia, causing impaired executive function and unusual gait parameters. However, the mechanism of neural function illustrating this is unclear. Our research aimed to explore the differences of cerebral cortex activation, gait parameters, and working memory performance between healthy older adults (HA) and older hypertensive (HT) patients when performing cognitive and walking tasks. A total of 36 subjects, including 12 healthy older adults and 24 older hypertensive patients were asked to perform series conditions including single cognitive task (SC), single walking task (SW), and dual-task (DT), wearing functional near-infrared spectroscopy (fNIRS) equipment and Intelligent Device for Energy Expenditure and Activity equipment to record cortical hemodynamic reactions and various gait parameters. The left somatosensory cortex (L-S1) and bilateral supplementary motor area (SMA) showed higher cortical activation (p<.05) than HA when HT performed DT. The intragroup comparison showed that HT had higher cortical activation (p<.05) when performing DT as SW. The cognitive performance of HT was significantly worse (p<.05) than HA when executing SC. The activation of the L-S1, L-M1, and bilateral SMA in HT were significantly higher during SW (p<.05). Hypertension can lead to cognitive impairment in the elderly, including executive function and walking function decline. As a result of these functional declines, elderly patients with hypertension are unable to efficiently allocate brain resources to support more difficult cognitive interference tasks and need to meet more complex task demands by activating more brain regions.

Effect of Mat Pilates Training on Blood Pressure, Inflammatory, and Oxidative Profiles in Hypertensive Elderly.

To determine the effects of mat Pilates training on blood pressure, inflammatory, and antioxidative markers in hypertensive elderly people, 34 hypertensive subjects aged 60-75 years were randomly divided into a control group (CON; n = 17) and a mat Pilates training group (MP; n = 17). The CON participants conducted normal daily activities and participated in neither organized exercises nor sports training, while those in the MP group received mat Pilates training for 60 min three times/week for 12 weeks. Parameters including blood pressure, cardiovascular function, nitric oxide (NO), tumor necrotic factor-alpha (TNF-α), superoxide dismutase (SOD), and malonaldehyde (MDA) were collected at baseline and the end of 12 weeks. The MP group had significantly decreased blood pressure, improved cardiovascular variables, decreased MDA and TNF-α, and increased NO and SOD compared with the CON group and the pre-training period (p < 0.05). In conclusion, these findings demonstrate the positive effects of 12 weeks of mat Pilates training in terms of reducing blood pressure and increasing blood flow related to improvements in anti-inflammatory and antioxidative markers in hypertensive elderly people. Mat Pilates training might be integrated as an alternative therapeutic exercise modality in clinical practice for hypertensive elderly individuals.

Effect of Gamelan and progressive muscle relaxation on blood pressure in hypertensive patients

Chronically elevated blood pressure was a prominent risk factor for cardiovascular diseases. The management of hypertension, especially in community settings, should combine pharmacological and non-pharmacological interventions. This study aimed to evaluate whether music-assisted progressive muscle relaxation (PMR) using Gamelan, Javanese classical music, could reduce blood pressure more effectively in hypertensive elderly individuals in Malang, Indonesia, than PMR alone. This study employed a pre-test and post-test study design with a control group. Fifty-eight respondents were randomly assigned to the intervention group (n = 31) and the control group (n = 27). Three respondents in the control group did not complete the study; thus, they were excluded from the analysis. The intervention group was trained and guided to perform PMR while listening to Gamelan. Meanwhile, the control group only received PMR. The intervention was conducted twice a week for 20 minutes for eight weeks. Dependent variables in this study were systolic and diastolic blood pressure, which were measured using an aneroid sphygmomanometer. Data were analyzed using descriptive statistics, paired t-tests, independent t-tests, and Mann-Whitney test. We found a significant decrease in systolic and diastolic blood pressure in both groups. A Mann-Whitney test showed that there was a significant difference in the reduction of systolic blood pressure in the intervention group compared to the control group (p = 0.000). Meanwhile, the independent t-test showed that the diastolic blood pressure in the intervention group reduced more significantly than that in the control group. The efficacy of Gamelan-assisted PMR in significantly reducing both systolic and diastolic blood pressure showcases the potential of such combined interventions in managing hypertension. We recommend Gamelan-assisted PMR as a complementary therapy for the elderly with primary hypertension.

Hipertansif Yaşlı Bireylerin Uyum Düzeyleri ve İlişkili Faktörler: Kesitsel Bir Çalışma

Objective: Patient adherence, particularly in the management of chronic diseases, is an often overlooked but crucial aspect that is more important than medication treatment itself. It is also one of the major problems contributing to treatment failures. Our study aims to evaluate the adherence levels of elderly hypertensive individuals residing in the city center of Edirne, as well as the factors influencing adherence levels. Methods: The study sample consists of 421 elderly hypertensive individuals registered with 52 primary healthcare units in the city center of Edirne. Data were collected using a questionnaire comprising 75 questions. The questionnaire included socio-demographic characteristics, factors that may affect patient adherence, and the Adaptation to Chronic Illness Scale consisting of 25 questions. Results: Of the participants, 226 (53.7%) were female and 195 (46.3%) were male. The participants had an average adaptation score of 87.04±9.77, with a minimum score of 62 and a maximum score of 116. Younger elderly individuals had higher adaptation scores. Adaptation scores were lower for widowed individuals, illiterate individuals, and those living alone. Participants who were informed about their illness and treatment, involved their families, and had family support had higher adaptation scores. Conclusions: The adherence levels of the elderly participants in our study were found to be below the expected level. Existing studies in the literature predominantly focus on medication adherence. Conducting studies that specifically target disease adaptation would enable a better understanding of patients and the development of new strategies to improve adherence levels.

Case Study: A Depiction of Blood Pressure Following Hatha Yoga Practice

Hatha Yoga, characterized by body posture formation techniques and controlled breathing exercises, seeks to maintain the body's natural equilibrium. Conversely, hypertension, marked by elevated blood pressure within the vascular system, is a persistent medical condition. Its prevalence increases with age, particularly in low and middle-income nations. This study explores the effect of Hatha Yoga exercises on blood pressure in elderly hypertensive patients at the Biaro Public Health Center in 2023. Employing a Quasi-Experimental One Group Pretest-Posttest Design, this research engaged a study population comprising individuals aged 45-59 years. Purposive sampling identified a sample of 12 participants. Over a 2-week period, data was collected utilizing an aneroid sphygmomanometer and observation sheets. Data analysis encompassed univariate and bivariate analyses, employing the paired t-test. The results revealed that the mean blood pressure in hypertensive patients prior to participating in Hatha Yoga was 155.50, whereas following the intervention, it reduced to 150.08. These outcomes indicated a substantial impact, as evidenced by a p-value of 0.030, surpassing the significance level α (0.05). In conclusion, Hatha Yoga exercises significantly influenced blood pressure in elderly hypertensive patients at the Biaro Public Health Center in 2023. Consequently, it is recommended that hypertensive elderly individuals incorporate regular and disciplined Hatha Yoga exercises into their routine to effectively manage their blood pressure.

Hypersensitive C-reactive protein as a potential indicator for predicting left ventricular hypertrophy in elderly community-dwelling patients with hypertension

BackgroundThe aim of this study was to investigate the relationship between Hypersensitive C-reactive protein (hs-CRP) and left ventricular hypertrophy (LVH) in elderly community-dwelling patients with hypertension.MethodsA cross-sectional study was conducted, involving the recruitment of 365 elderly hypertensive residents ≥ 65 years of age from five communities. The participants were divided into two groups: an LVH group (n = 134) and a non-LVH group (n = 231), based on the left ventricular mass index (LVMI) determined by echocardiography. Spearman correlation analysis was used to assess the relationship between hs-CRP and LVH. Univariate and Multivariate analysis was performed to detect variables associated with LVH. The diagnostic value of hs-CRP for LVH was expressed as the area under the receiver operating characteristic (ROC) curve.ResultsThe incidence of LVH in elderly hypertension patients in the community was 36.7%. The hs-CRP levels were significantly higher in subjects with LVH compared to those without LVH (1.9 [0.8, 2.9] vs. 0.7 [0.4, 1.4], P = 0.002). Spearman correlation analysis demonstrated a positive correlation between hs-CRP and LVMI (r = 0.246, P < 0.001), as well as with IVST (r = 0.225, P < 0.001) and LVPWT (r = 0.172, P = 0.001). Among elderly hypertensive residents in the community, the cut-off value of hs-CRP for diagnosing LVH was 1.25 mg/L (sensitivity: 57.5%; specificity: 78.4%), and the area under the ROC curve for hs-CRP to predict LVH was 0.710 (95%CI: 0.654–0.766; P < 0.001). In the final model, hs-CRP ≥ 1.25 mg/L (OR = 3.569; 95%CI, 2.153–5.916; P<0.001) emerged as an independent risk factor for LVH. This association remained significant even after adjusting for various confounding factors (adjusted OR = 3.964; 95%CI, 2.323–6.765; P < 0.001).ConclusionsThis community-based cohort of elderly hypertensive individuals demonstrates a strong association between hs-CRP levels and the presence of LVH. The hs-CRP ≥ 1.25 mg/L may serve as an independent predictor for LVH in hypertensive subjects and exhibit good diagnostic efficacy for LVH.

Benefit of treatment based on indapamide mostly combined with perindopril on mortality and cardiovascular outcomes: a pooled analysis of four trials.

The aim of this study was to assess the reduction in all-cause death and cardiovascular outcomes associated with the administration of the thiazide-like diuretic indapamide monotherapy or in combination with perindopril as a blood pressure lowering drug in randomized controlled trials (RCTs). Aggregate data from four published RCTs conducted versus matching placebo were pooled: PATS, a 2-year study (indapamide), and PROGRESS, a 4-year study (indapamide and perindopril), both in patients with a history of stroke or transient ischemic attack; ADVANCE, a 4-year study in patients with type 2 diabetes and cardiovascular risk factor (single-pill combination perindopril/indapamide) and HYVET, a 2-year study in very elderly hypertensive individuals (indapamide and an option of perindopril). The pooled effect (fixed and random) estimate (hazard ratio) was reported with corresponding 95% confidence intervals and P values. Treatment discontinuations were also analysed to assess the net benefit of the treatment. The population involved 24 194 patients (active: 12 113, placebo: 12 081). The fixed-effects meta-analysis of the three mortality endpoints found low statistical heterogeneity ( I2 = 0). Statistically significant risk reductions in the indapamide with or without perindopril-treated patients as compared to placebo were observed for all-cause death (-15%), cardiovascular death (-21%), fatal stroke (-36%) and all strokes (-27%). Other cardiovascular outcomes were improved (risk reduction, 22 to 36%). As expected, discontinuation rates for safety (two studies) were higher in the active group (6.4 vs. 3.9%), while they were similar when discontinuation for any reason is concerned (18.4 vs. 18.0%). Across medium to high cardiovascular risk population, long-term indapamide, mostly combined with perindopril-based treatment, provided evidence of benefit on mortality and morbidity.

Cardiac Behavior and Heart Rate Variability in Elderly Hypertensive Individuals during Aerobic Exercise: A Non-Randomized Controlled Study.

High blood pressure is an important public health problem due to its high prevalence, the difficulty to control it, and its high contribution to morbidity. A series of changes may be linked to the aging process, compromising cardiac conduction, and reducing cardiovascular baroreceptor function. Advancing age promotes a decline in heart rate variability and this decrease can increase the probability of cardiovascular disease. The aim of this study was to analyze the autonomic modulation of heart rate in hypertensive elderly individuals during and after a session of aerobic exercise, and to compare it with elderly individuals without cardiovascular or metabolic disease. Our study was a non-randomized controlled study with hypertensive elderly (HBP group) and elderly without cardiovascular and/or metabolic diseases (control group). Data on blood pressure and heart rate variability (HRV) were collected before, during, and after 30 min of aerobic physical exercise on a treadmill. There was a reduction in HF (ms2) and SD1 (ms) in the 5 min of recovery for the elderly in the control group. The elderly in the control group also had greater RMSSD and SD1 30 min post-exercise when compared to the initial mins of recovery. We concluded that there was no difference in autonomic modulation and global heart rate variability between elderly individuals without cardiovascular and metabolic diseases and hypertensive individuals after a bout of aerobic exercise. Elderly individuals without metabolic diseases showed a decrease in parasympathetic modulation and global variability between the time of rest and 5 min of recovery. However, up to 30 min of post-exercise recovery, they restored parasympathetic activity.

Ambulatory diastolic blood pressure: a marker of comorbidity in elderly fit hypertensive individuals?

BACKGROUNDMasked diastolic hypotension is a new blood pressure (BP) pattern detected by ambulatory blood pressure monitoring (ABPM) in elderly hypertensives. The aim of this study was to relate ABPM and comorbidity in a cohort of fit elderly subjects attending an outpatient hypertension clinic.METHODSComorbidity was assessed by Charlson comorbidity index (CCI) and CHA2DS2VASc score. All subjects evaluated with ABPM were aged ≥ 65 years. CCI and CHA2DS2VASc score were calculated. Diastolic hypotension was defined as mean ambulatory diastolic BP < 65 mmHg and logistic regression analysis was carried out in order to detect and independent relationship between comorbidity burden and night-time diastolic BP < 65 mmHg. RESULTSWe studied 174 hypertensive elderly patients aged 72.1 ± 5.2 years, men were 93 (53.4%). Mean CCI was 0.91 ± 1.14 and mean CHA2DS2VASc score of 2.68 ± 1.22. Subjects with night-time mean diastolic values < 65 mmHg were higher in females [54.7% vs. 45.3%, P = 0.048; odds ratio (OR) = 1.914, 95% CI: 1.047−3.500]. Logistic regression analysis showed that only CHA2DS2VASc score was independently associated with night-time mean diastolic values < 65 mmHg (OR = 1.518, 95% CI: 1.161−1.985; P = 0.002), but CCI was not. CONCLUSIONSABPM and comorbidity evaluation appear associated in elderly fit subjects with masked hypotension. Comorbid women appear to have higher risk for low ambulatory BP.

Hemodynamics and functional outcomes after resistance training in hypertensive and normotensive elderly: An experimental study

Aim: To evaluate the chronic effects of resistance training on resting blood pressure, handgrip strength, gait speed, and Timed Up and Go test (TUG) in normotensive and hypertensive elderly individuals. Methods: Experimental study based on TREND. Hypertensive patients were diagnosed by an independent doctor. Before and after 12 weeks of progressive resistance training, we evaluated blood pressure, heart rate, body composition, Timed Up and Go test, gait speed, and handgrip strength. Results: Sample consisted of 41 participants divided into two groups (normotensive n = 28; hypertensive n = 13). We observed significant values in the reduction of blood pressure levels only in the group of hypertensive participants. In functionality outcomes, we observed significant values in all tests and both groups. Outcomes contemplate effect sizes ranging from small to moderate. Conclusion: Progressive resistance training lowers resting blood pressure levels, increases handgrip strength, and improves physical functional performance. Although the normotensive group did not show a reduction in blood pressure levels, an improvement was observed in the functional physical tests.

Performance of the Electrocardiogram in the Diagnosis of Left Ventricular Hypertrophy in Older and Very Older Hypertensive Patients.

ResumoFundamento:A hipertrofia ventricular esquerda (HVE) é um importante fator de risco cardiovascular, independente da hipertensão arterial. Apesar da evolução dos exames de imagem, o eletrocardiograma (ECG) ainda é o mais utilizado na avaliação inicial, porém, com baixa sensibilidade.Objetivo:Avaliar o desempenho dos principais critérios eletrocardiográficos para HVE em indivíduos hipertensos idosos e muito idosos.Métodos:Em coorte de hipertensos foram realizados ECGs e EcoDopplercardiogramas (ECO), e separados em três grupos etários: <60 anos, Grupo I; 60-79 anos Grupo II; e ≥80 anos, Grupo III. Os critérios eletrocardiográficos mais utilizados foram aplicados para o diagnóstico da HVE: Perúgia; Peguero-Lo Presti; Gubner-Ungerleider; Narita; (Rm+Sm) x duração; Cornell voltagem; Cornell voltagem duração; Sokolow-Lyon voltagem; R de aVL ≥11 mm; RaVL duração. Na avaliação do desempenho desses critérios, além da sensibilidade (Sen) e especificidade (Esp), foram analisadas as “Odds Ratios diagnóstico” (DOR). Consideramos p-valor <0,05 para as análises, com testes bi-caudais.Resultados:Em 2.458 pacientes, a HVE estava presente pelo ECO em 781 (31,7%). Nos Grupos I e II, os melhores desempenhos foram para os critérios de Narita, Perúgia, (Rm+Sm) x duração, sem diferenças estatísticas entre eles. No Grupo III (muito idosos) os critérios de Perúgia e (Rm+Sm) x duração tiveram os melhores desempenhos: Perúgia [44,7/89,3; (Sen/Esp)] e (Rm+Sm) duração [39,4%/91,3%; (Sen/Esp), p<0,05)], com os melhores resultados de DOR:6,8. Isto sugere que nessa população de muito idosos esses critérios têm maior poder discriminatório para separar pacientes com HVE.Conclusão:Nos hipertensos muito idosos os critérios eletrocardiográficos de Perúgia e (Rm+Sm) x duração apresentaram os melhores desempenhos diagnósticos para HVE.

Hematological detraining-related changes among elderly individuals with high blood pressure

The aim of the present study was to compare the effects of detraining on physical performance, blood pressure, biologic and anthropometric variables of hypertensive elderly individuals, grouped by two levels of previous physical activity. A total of 87 elderly individuals (70 to 93 years old) with systolic/diastolic blood pressure levels above 120/80 mmHg who participated during 18 non-consecutive months in 2 years in physical exercise programs offered in northern Portugal communities were included in the study. Tests were performed before and after three months of no exercise. Attendance to the exercise sessions, hematological markers, cardiorespiratory function, and anthropometric variables were assessed. The results were analyzed according to the fulfillment of the WHO recommendations on moderate physical activity (at least 150 minutes/week). Weight, total cholesterol, and glucose were influenced by the amount of physical activity performed previously to the detraining period. After the detraining period, the total cholesterol, glucose, insulin, and weight had significant differences influenced by the amount of physical activity previously performed (p<0.05). The number of minutes per week of aerobic and resistance exercise training over 18 non-consecutive months was not a significant determinant factor in the development of hypertension during the three months of detraining.

THE COMBINATION OF RENAL DYSFUNCTION AND MUSCLE MASS REDUCTION IS ASSOCIATED WITH ARTERIAL STIFFNESS IN ELDERLY INDIVIDUALS

Objective: Epidemiological studies have found that both renal dysfunction and muscle mass reduction (sarcopenia) are associated with the target organ damage and future risk of cardiovascular disease. This study aimed to examine whether the renal dysfunction, muscle mass reduction, and their combination related to arterial stiffness among elderly individuals. Design and method: From the participants in Wakayama study, a total of 552 normotensive and untreated hypertensive elderly individuals (mean age, 69.5 ± 3.6 years) without a history of stroke, coronary heart disease and renal disease was enrolled in this study. Brachial-ankle pulse wave velocity (baPWV) was measured by a simple automatic oscillometric technique and used as index of arterial stiffness. The skeletal muscle mass(SM) of the whole body was estimated by a bioelectrical impedance analysis. The renal dysfunction was evaluated by a glomerular filtration rate (eGFR) correlated by body surface area. Results: The eGFR and SM of subjects decreased with increase in age, and the values were significantly higher in men than women. The eGFR was positively correlated with SM in both genders. We divided the subjects into four groups according to eGFR and SM levels; namely, high-eGFR (> = 60 ml/min/1.73 m2) + high SM (> = age- and gender-specific median value) group (n = 228), high-eGFR + low-SM group (n = 189), low-eGFR + high-SM group (n = 58) and low-eGFR + low-SM group (n = 77). There was no significant difference in blood pressure between the four groups. The baPWV was the highest in the low-eGFR + low-SM group (1,751 cm/s), and followed by the high-eGFR + low-SM group (1,708 cm/s), the low-eGFR + high-SM group (1,687 cm/s) and the high-eGFR + high-SM group (1,610 cm/s). After adjustment for age and gender, the baPWV in the high-eGFR + low-SM group was significantly higher than that in the high-eGFR + high-SM group (p = 0.006); whereas no significant difference between the low-eGFR + high-SM group and the high-eGFR + high-SM group (p = 0.502). Conclusions: In elderly individuals, the combination of renal dysfunction and muscle mass reduction may contribute to the acceleration of arterial stiffening relative to the condition that they exist solely.

MPS 10-04 THE COMBINATION OF OBESITY AND SARCOPENA IS ASSOCIATED WITH COGNITIVE DECLINE IN ELDERLY HYPERTENSIVE INDIVIDUALS

The combination of obesity and sarcopenia, defined as sarcopenic obesity, may contribute to cognitive decline more than the two conditions exist solely. This study aimed to investigate the risk of cognitive impairment associated with the sarcopenia, obesity, and its combination among elderly hypertensive individuals. A total of 348 elderly hypertensive subjects (175 men and 173 women, 69.5 ± 2.9 years of age), was enrolled in this study. We evaluated the cognitive functioning of individuals based on the 12-signs version of the Observations List for early signs of Dementia (OLD). Bioelectrical impedance analysis was performed to estimate appendicular skeletal muscle mass (ASM). A value of ASM was normalized for height and conversed to an ASM index. Subject with an ASM index of less than the gender-specific lowest quartiles was classified as sarcopenic. Obesity was defined as waist circumference greater than 85 cm for men and 90 cm for women. Based on the cutoffs, four categorical groups were created as solely sarcopenic (sarcopenic non-obese), solely obese (non-sarcopenic obese), sarcopenic obese, and normal. The OLD score was highest (namely, cognitive functioning was lowest) among the sarcopenic obese group (5.3 ± 0.7 points), followed by non-sarcopenic obese group (3.3 ± 0.2 points), the sarcopenic non-obese group (3.4 ± 0.3 points), and normal group (2.8 ± 0.2 points) after adjusting for confounding factors (p for trend <.001). When a cognitive decline was defined as the OLD score of 5 points or above, 25.9% of the subjects met the criteria. Multiple logistic regression analysis revealed that the sarcopenic obese condition was significantly associated with the increased risk for cognitive decline (odds ratio, 4.0; 95% CI, 1.3–12.0; P<.05), independent of age, gender, education level, and use of anti-hypertensive agents. In elderly hypertensive individuals, the combination of obesity and sarcopenia may contribute to the acceleration of cognitive decline relative to the condition that they exist solely.

Current challenges in antihypertensive treatment in the elderly.

Arterial hypertension affects more than 25% of the global population, and its prevalence is increasing with age. Arterial stiffening occurs with aging and results in a pattern of increased systolic and decreased diastolic blood pressure (BP). In the elderly population, elevated BP has been related with increased cardiovascular risk. Trials on this population have shown great benefits for morbidity and mortality from reducing systolic BP (SBP) levels to less than 150 mmHg. Most guidelines for the management of elderly hypertensive patients agree on BP reduction to less than 150/90 mmHg. However, there is still uncertainty whether further BP reduction could provide beneficial results. The recently published SPRINT trial demonstrated that reducing SBP to between 120 and 125 mmHg in patients over the age of 75 years is related with increased survival and is expected to affect future recommendations. On the contrary, the limited data that are available for octogenarians and frail nursing home patients create concerns for more aggressive BP strategies in these subgroups, and thus they should be treated more conservatively. Among the various antihypertensive classes of drugs, diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers were proved beneficial in the elderly and are favored as first choices for the management of elderly hypertensive individuals. Given the common coexistence of other comorbidities and polypharmacy, physicians should be careful when initiating or uptitrating treatments to avoid potential adverse events or interaction with other drugs or diseases.