Elderly Hypertensive Patients Research Articles

Impact of Hypertension Duration on the Cardiovascular Benefit of Intensive Blood Pressure Control.

The optimal timing for initiating intensive systolic blood pressure (SBP) treatment remains unclear. While longer hypertension duration is positively associated with increased cardiovascular disease risk, it is unknown whether patients with prolonged hypertension can derive similar benefits from intensive SBP treatment. From the STEP trial (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients), 8442 participants with complete hypertension duration data were categorized by hypertension duration ≤5 years, 5 to 10 years, 10 to 15 years, and >15 years. The primary outcome was a composite of cardiovascular events. Hazard ratios were calculated using the Fine-Gray subdistribution hazard model. The incidences of the primary outcome increased significantly in patients with hypertension over 15 years than those <5 years in the standard SBP treatment group (adjusted hazard ratios, 1.68 [95% CI, 1.11-2.56]) but not in the intensive treatment group. Each 1-year increase in hypertension duration continuously increased the adjusted risk of major cardiovascular events by 4% (95% CI, 1.01-1.08) up to 20 years, plateauing at an adjusted hazard ratio of 2.27 (95% CI, 1.28-4.04). After intensive SBP treatment, the incidences of major cardiovascular events were similar across different hypertension duration groups, which were 2.22%, 1.69%, 3.02%, and 2.52%, respectively (P>0.05). Subgroup analyses indicated a potential sex difference in this relationship between hypertension duration and the primary outcome in the standard SBP treatment group (Pinteraction=0.05). Initiating intensive SBP treatment at any stage of hypertension duration could reduce cardiovascular disease risk to a comparable level. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03015311.

Influence of multiple risk factor control level on cardiovascular outcomes in hypertensive patients.

The relationship between the level of baseline risk factor control and cardiovascular outcomes in hypertensive patients with blood pressure intervention is not well understood. It is also unclear whether the level of baseline risk factor control is persuasively associated with cardiovascular outcomes in hypertensive patients with blood pressure lowering strategy. We performed an analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients (STEP) trial. Participants without complete baseline risk factor data were excluded. The primary outcome was a composite of cardiovascular events and all-cause mortality. Cox proportional hazard models were used to calculate the hazard ratio (HR) and estimate association between risk factor control levels (≥6, 5, 4, and≤3) and cardiovascular outcomes. A total of 8337 participants were involved in the analysis and the median follow-up period was 3.19 years. Each additional risk factor uncontrolled was associated with a 24% higher cardiovascular risk (HR 1.24, 95% CI 1.11-1.37). Compared with participants with optimal risk factor control, those with≤3 factors control exhibited 95% higher cardiovascular risk (HR 1.95, 95% CI 1.37-2.77). The corresponding protective effects of multiple risk factor modification were not influenced by intensive or standard antihypertensive treatment (P for interaction=0.71). A stepwise association was observed between cardiovascular risk and the number of risk factor control in hypertensive patients. The more risk factor was modified, the less cardiovascular risk was observed, irrespective of different blood pressure lowering strategies. Comprehensive risk factor control strategies are warranted to reduce cardiovascular disease risk in hypertensive patients. Trial registration STEP ClinicalTrials.gov number, NCT03015311. Registered 2 January 2017.

A Meta-analysis of Intensive and Standard Antihypertensive Safety in Elderly Hypertensive Patients

Objective: To evaluate the effect of intensive and standard antihypertensive pressure on cardiovascular and cerebrovascular events, serious adverse events and all-cause deaths in elderly hypertensive patients. Methods: Pubmed, Embase, Cochrane, CNKI, Wanfang and CBM databases were searched. All of the included studies were the RCT trials. Relative risk (RR) and 95% confidence interval (95%CI) were used to evaluate differences in enhanced and standard antihypertensive outcomes. Statistical analysis was applied using the Stata 17.0 software. Results: Seven tests were retrieved to meet the conditions, Different antihypertensive effects showed overall statistical differences in the incidence of cardiovascular and cerebrovascular events, Significant decrease in the intensive antihypertensive group [P=0.000, RR95%CI:0.79(0.69-0.90)], Among them, the incidence of acute myocardial infarction (AMI) and acute coronary syndrome (ACS) was significantly reduced in the intensive antihypertensive group [P=0.000, RR95%CI:0.62(0.48-0.81)], The incidence of stroke events was significantly fewer in the intensive group [P=0.000, RR95%CI:0.62(0.48-0.81)]; There was no significant difference in the incidence of acute HF (AHF) between the two groups [P=0.242, RR95%CI:0.55(0.20-1.50)]. There was no significant statistical difference in the incidence of serious adverse events overall by different antihypertensive criteria [P=0.251,RR95%CI:1.12(0.92-1.36)], of which two groups were eGFR&lt;30ml/min/1.73m2There was no significant statistical difference in the incidence [P=0.280,RR95%CI:1.46(0.74-2.89)], no significant statistical difference in the incidence of orthostatic hypotension [P=0.473,RR95%CI:1.47(0.51-4.23)], no significant statistical difference in the incidence of falls [P=0.607,RR95%CI:1.24(0.54-42.86)], and the incidence of syncope in the intensive antihypertensive group was higher than that in the standard antihypertensive group [P=0.009,RR95%CI:2.43(1.24-4.77)]. There was no significant statistical difference in the effect of different antihypertensive criteria on all-cause death [P=0.156,RR95%CI:0.92(0.81-1.03)]. Conclusion: Compared with the standard antihypertensive in elderly patients with hypertension, there is no significant statistical difference in the incidence of serious adverse events and all-cause mortality in the elderly, and the incidence of cardiovascular and cerebrovascular events in the elderly.

A Meta-analysis of Intensive and Standard Antihypertensive Safety in Elderly Hypertensive Patients

Objective: To evaluate the effect of intensive and standard antihypertensive pressure on cardiovascular and cerebrovascular events, serious adverse events and all-cause deaths in elderly hypertensive patients. Methods: Pubmed, Embase, Cochrane, CNKI, Wanfang and CBM databases were searched. All of the included studies were the RCT trials. Relative risk (RR) and 95% confidence interval (95%CI) were used to evaluate differences in enhanced and standard antihypertensive outcomes. Statistical analysis was applied using the Stata 17.0 software. Results: Seven tests were retrieved to meet the conditions, Different antihypertensive effects showed overall statistical differences in the incidence of cardiovascular and cerebrovascular events, Significant decrease in the intensive antihypertensive group [P=0.000, RR95%CI:0.79(0.69-0.90)], Among them, the incidence of acute myocardial infarction (AMI) and acute coronary syndrome (ACS) was significantly reduced in the intensive antihypertensive group [P=0.000, RR95%CI:0.62(0.48-0.81)], The incidence of stroke events was significantly fewer in the intensive group [P=0.000, RR95%CI:0.62(0.48-0.81)]; There was no significant difference in the incidence of acute HF (AHF) between the two groups [P=0.242, RR95%CI:0.55(0.20-1.50)]. There was no significant statistical difference in the incidence of serious adverse events overall by different antihypertensive criteria [P=0.251,RR95%CI:1.12(0.92-1.36)], of which two groups were eGFR&lt;30ml/min/1.73m2There was no significant statistical difference in the incidence [P=0.280,RR95%CI:1.46(0.74-2.89)], no significant statistical difference in the incidence of orthostatic hypotension [P=0.473,RR95%CI:1.47(0.51-4.23)], no significant statistical difference in the incidence of falls [P=0.607,RR95%CI:1.24(0.54-42.86)], and the incidence of syncope in the intensive antihypertensive group was higher than that in the standard antihypertensive group [P=0.009,RR95%CI:2.43(1.24-4.77)]. There was no significant statistical difference in the effect of different antihypertensive criteria on all-cause death [P=0.156,RR95%CI:0.92(0.81-1.03)]. Conclusion: Compared with the standard antihypertensive in elderly patients with hypertension, there is no significant statistical difference in the incidence of serious adverse events and all-cause mortality in the elderly, and the incidence of cardiovascular and cerebrovascular events in the elderly.

The Effect of Preventive Care and Rehabilitation Nursing on Elderly Hypertension

Objective: To improve the effectiveness of elderly hypertension care, this research applied preventive care and rehabilitation nursing in clinical nursing to clarify their impact on elderly hypertension. Methods: A total of 95 elderly hypertensive patients who received diagnosis and treatment in the hospital during the period of January 2023 to December 2023 were analyzed. They were divided into a control group (49 cases) and an observation group (46 cases) in order of diagnosis and treatment. The patients in the control group were implemented conventional care methods, and the patients in the observation group using preventive care and rehabilitation nursing, the intervention effect between the two groups were analyzed. Results: Compared with the control group, in terms of clinical indicators and blood pressure and blood lipids, the observation group had lower values (P&lt;0.05). In terms of healthy behavior, the observation group had higher values (P&lt;0.05). Conclusion: Implementing preventive care and rehabilitation nursing in clinical nursing can have a positive impact on elderly patients with hypertension, which is beneficial for stabilizing clinical indicators, blood pressure indicators, blood lipid indicators, thus improving patients’ health behavior.

The Effect of Preventive Care and Rehabilitation Nursing on Elderly Hypertension

Objective: To improve the effectiveness of elderly hypertension care, this research applied preventive care and rehabilitation nursing in clinical nursing to clarify their impact on elderly hypertension. Methods: A total of 95 elderly hypertensive patients who received diagnosis and treatment in the hospital during the period of January 2023 to December 2023 were analyzed. They were divided into a control group (49 cases) and an observation group (46 cases) in order of diagnosis and treatment. The patients in the control group were implemented conventional care methods, and the patients in the observation group using preventive care and rehabilitation nursing, the intervention effect between the two groups were analyzed. Results: Compared with the control group, in terms of clinical indicators and blood pressure and blood lipids, the observation group had lower values (P&lt;0.05). In terms of healthy behavior, the observation group had higher values (P&lt;0.05). Conclusion: Implementing preventive care and rehabilitation nursing in clinical nursing can have a positive impact on elderly patients with hypertension, which is beneficial for stabilizing clinical indicators, blood pressure indicators, blood lipid indicators, thus improving patients’ health behavior.

Awareness: the Golden Key to Understanding Healthcare Seeking Behavior among Elderly Hypertensive Patients in Taft, Iran

Introduction: Healthcare seeking behavior is crucial for early detection and proper management of hypertension in the elderly. This study investigated the factors influencing healthcare seeking behavior among elderly hypertensive patients residing in Taft, Iran. Methods: This cross-sectional study recruited 230 hypertensive individuals aged 60 and above residing in Taft, Yazd Province, Iran. Participants were randomly selected and completed a questionnaire through face-to-face interviews. The questionnaire assessed their healthcare seeking behaviors and potential influencing factors. Data analysis was performed using SPSS software. Correlation tests and linear regression analysis were employed to identify significant relationships (p &lt; 0.05). Results: A significant majority (70%) of participants reported always paying attention to symptoms of high blood pressure. When experiencing symptoms, over half (53.9%) of the participants indicated a preference for visiting health centers, general practitioners' offices, or emergency departments. Among the factors studied, awareness (B = 0.228) emerged as the most significant positive predictor of healthcare seeking behavior (p &lt; 0.05). Other positive influences included decision-making autonomy (B = 0.177), prior experience with healthcare services (B = 0.131), and social support (B = 0.131) – all statistically significant at p &lt; 0.05. Conversely, barriers to healthcare seeking had a negative and significant impact (B = - 0.064, p &lt; 0.05). Collectively, the investigated factors explained 23% of the variation observed in healthcare seeking behavior among the elderly participants (R2 = 0.23). Conclusion: This study identified awareness of hypertension as the strongest predictor of healthcare seeking behavior in elderly patients. Additionally, providing accessible and supportive healthcare services can further encourage elderly hypertensive patients to seek necessary care.

Effectiveness of Spironolactone in Reducing Osteoporosis and Future Fracture Risk in Middle-Aged and Elderly Hypertensive Patients.

While the role of aldosterone in bone metabolism is well established, the specific effects of the widely used aldosterone antagonist, spironolactone, on bone health are not fully understood. This study aimed to investigate the effects of spironolactone on osteoporosis and future fracture risk in middle-aged and elderly hypertensive patients, revealing its potential benefits for bone health. Propensity score matching was employed in this study to create matched groups of spironolactone users and non-users at a 1:4 ratio. We investigated the association between spironolactone use and the risk of osteoporosis using multivariate logistic regression analysis. Furthermore, we conducted multivariate linear regression analysis to explore the relationship between cumulative dosage and the FRAX score. Subgroup analysis was also performed to assess the effects under different stratification conditions. In both pre-match and post-match analyses, multivariable logistic regression revealed a significant reduction in the risk of osteoporosis in the spironolactone usage group (pre-match: odds ratios [OR] 0.406, 95% confidence interval [CI], 0.280-0.588; post-match: OR 0.385, 95% CI, 0.259-0.571). Furthermore, post-match multivariable linear regression demonstrated a clear negative correlation between cumulative spironolactone dosage and the FRAX score. Subgroup analyses consistently supported these findings. This study offers evidence supporting the significant positive impact of the antihypertensive drug spironolactone on bone health, resulting in a substantial reduction in the risk of osteoporosis and future fractures in hypertensive patients. Future research should consider conducting large-scale, multicenter, randomized controlled trials to further investigate the long-term effects of spironolactone on bone health in hypertensive patients.

Association of frailty status with overall survival in elderly hypertensive patients: based on the Chinese Longitudinal Healthy Longevity Survey

BackgroundHypertension and frailty often coexist in older people. The present study aimed to evaluate the association of frailty status with overall survival in elderly hypertensive patients, using data from the Chinese Longitudinal Healthy Longevity Survey.MethodsA total of 10,493 elderly hypertensive patients were included in the present study (median age 87.0 years, 58.3% male). Frailty status was assessed according to a 36-item frailty index (FI), which divides elderly individuals into four groups: robustness (FI ≤ 0.10), pre-frailty (0.10 < FI ≤ 0.20), mild-frailty (0.20 < FI ≤ 0.30), and moderate-severe frailty (FI > 0.30). The study outcome was overall survival time. Accelerated failure time model was used to evaluate the association of frailty status with overall survival.ResultsDuring a period of 44,616.6 person-years of follow-up, 7327 (69.8%) participants died. The overall survival time was decreased with the deterioration of frailty status. With the robust group as reference, adjusted time ratios (TRs) were 0.84 (95% confidence interval [CI]: 0.80–0.87) for the pre-frailty group, 0.68 (95% CI: 0.64–0.72) for the mild frailty group, and 0.52 (95% CI: 0.48–0.56) for the moderate-severe frailty group, respectively. In addition, restricted cubic spline analysis revealed a nearly linear relationship between FI and overall survival (p for non-linearity = 0.041), which indicated the overall survival time decreased by 17% with per standard deviation increase in FI (TR = 0.83, 95% CI: 0.82–0.85). Stratified and sensitivity analyses suggested the robustness of the results.ConclusionsThe overall survival time of elderly hypertensive patients decreased with the deterioration of frailty status. Given that frailty is a dynamic and even reversible process, early identification of frailty and active intervention may improve the prognosis of elderly hypertensive patients.

Effect Of Murottal Al-Quran Letter Asy-Syu'ara Therapy On Blood Pressure In Hypertension Patients

Hypertension is a major public health problem. There are two ways to treat high blood pressure: drug therapy and non-drug therapy. Treatment includes the use of antihypertensive drugs that have been shown to lower blood pressure. Meanwhile, non-drug treatments for high blood pressure include Murotal Al-Quran. The aim of this study was to analyze the effect of mulottal therapy verses 1 to 97 of Surah Asi-Shuara Al-Quran on the blood pressure of hypertensive patients in Poshandu in the Banyuanyar Community Health Center area. The research design used was a one group pre-post test design using a simple random sampling technique. The intervention took the form of offering Mulottar Al-Quran Surah Asi Shuara verses 1 to 97 for 15 minutes for three consecutive days. The total sample consisted of 41 hypertensive patients. The results of the Wilcoxon sign-rank test between pre and post test blood pressure in the Banyuan Yar Community Health Center work area showed = 0.002 and the comparative significance value = 0.05. Statistics = 0.002 &lt; 0.05. The trial results showed that Murotar Al-Quran Surah As Shuara Therapy was effective on the blood pressure of elderly hypertensive patients in Poshandu in the Banyuanyar Community Health Center working area. In conclusion, Murottar Therapy according to the Al-Quran Surah Asi Shuara has been proven to be effective in reducing blood pressure in hypertensive patients. The suggestion is that hypertensive patients can use Al-Quran Surah Asi Shuara mulottal therapy to lower their blood pressure.

#217 Renin-angiotensin-aldosterone system blockers effect in CKD progression in hypertensive elderly patients without proteinuria: PROERCAN trial

Abstract Background and Aims Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. Method Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3-4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years (Figure). Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. Results 88 patients were included with a mean age of 77.9 ± 6.1 years and a follow up period of 3 years: 40 were randomised to RAAS group and 48 to standard treatment. Etiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown etiology. In the RAAS group eGFR slope during follow up was −4.3 ± 1.1 ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6 ± 0.4 ml/min), p = 0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. Conclusion In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression.

Correlation between vitamin D levels and blood pressure in elderly hypertensive patients with osteoporosis.

The association between vitamin D and blood pressure in elderly patients with hypertension complicated by osteoporosis remains unclear. The objective of this study is to explore whether vitamin D deficiency contributes to elevated blood pressure in elderly individuals with both hypertension and osteoporosis. This study represents a single-center retrospective observational investigation carried out at the Zhongshan Hospital Affiliated to Xiamen University. Ambulatory blood pressure, bone density, vitamin D levels, and additional laboratory parameters were collected upon admission. The association between vitamin D and ambulatory blood pressure outcomes was assessed using Spearman correlation tests and partial correlation analyses. The relationship between vitamin D and changes in blood pressure was analyzed through Generalized Additive Models, and threshold analysis was conducted to explore potential thresholds. 139 patients with newly diagnosed osteoporosis were consecutively included (mean age 73 years, 84.9% female). There is a negative correlation between 25-(OH) D3 and 24 h mean systolic blood pressure (mSBP), diurnal mSBP, nocturnal mSBP, maximum SBP, respectively. The results of the generalized additive model analysis show that there is a nonlinear relationship between 25-(OH) D3 and 24 h mSBP, diurnal mSBP, nocturnal mSBP, respectively. After determining the critical point of 25-(OH) D3 as 42 nmol/L, a segmented linear regression model was used to calculate the effect size and 95% confidence interval on both sides of the critical point. When 25-(OH) D3 is ≤42 nmol/L, it significantly negatively correlates with 24 h, diurnal, and nocturnal mean SBP. Conversely, when 25-(OH) D3 exceeds 42 nmol/L, there is no statistically significant association with 24 h, diurnal, or nocturnal mSBP. There was a significant negative correlation between vitamin D levels and blood pressure levels in elderly patients with hypertension and osteoporosis.

Association of systemic inflammatory response index with bone mineral density, osteoporosis, and future fracture risk in elderly hypertensive patients

ABSTRACT Objectives This study sought to investigate the relationship between the systemic inflammatory response index (SIRI) and bone mineral density (BMD), osteoporosis, and future fracture risk in elderly hypertensive patients. Methods Elderly hypertensive patients (age ≥60 years) who attended our hospital between January 2021 and December 2023 and completed BMD screening were included in the study. Analyses were performed with multivariate logistic and linear regression. Results The multiple linear regression indicated that SIRI levels were significantly negatively correlated with lumbar 1 BMD (β = -0.15, 95% CI: −0.24, −0.05), lumbar 2 BMD (β = -0.15, 95% CI: −0.24, −0.05), lumbar 3 BMD (β = -1.35, 95% CI: −0.23, −0.02), lumbar 4 BMD (β = -0.11, 95% CI: −0.30, −0.10), femur neck BMD (β = -0.11, 95% CI: −0.18, −0.05) and Ward’s triangle BMD (β = -0.12, 95% CI: −0.20, −0.05) among elderly hypertensive patients, after fully adjusting for confounders. Furthermore, we observed that SIRI was positively associated with future fracture risk in elderly hypertensive patients. Specifically, SIRI was associated with an increased risk of major osteoporotic fractures (β = 0.33) and hip fractures (β = 0.25). The logistic regression analysis indicated that there is an association between the SIRI level and an increased risk of osteoporosis (OR = 1.60, 95% CI = 1.37, 1.87), after fully adjusting for confounders. Conclusions Our findings indicate a potential association between SIRI and BMD, osteoporosis, and the risk of future fractures in elderly hypertensive patients. However, further studies are warranted to confirm these findings.

The association of depressive symptoms with adverse clinical outcomes in hypertension: Data from SPRINT randomized trail

ObjectiveThis study intends to explore the effect of depressive symptoms on adverse clinical outcomes in middle-aged and elderly hypertensive patients. MethodsThis post hoc analysis was conducted using data from the Systolic Blood Pressure Intervention Trial (SPRINT), and we used cox proportional risk regression to examine the relationship between depressive symptoms and adverse clinical outcomes (primary outcome, all-cause mortality, cardiovascular disease(CVD) mortality, heart failure(HF), myocardial infarction(MI), non-myocardial infarction acute coronary syndrome(non-MI ACS)). ResultsIn a follow-up study of 9259 participants, we found that depression symptoms was significantly and positively associated with the primary outcome (HR 1.03, 95%CI 1.01–1.05; p for trend = 0.0038), all-cause mortality (HR 1.03, 95%CI 1.01–1.05; p for trend = 0.0308), HF(HR 1.05, 95%CI 1.01–1.08; p for trend = 0.0107), and non-MI ACS(HR 1.06, 95%CI 1.01–1.10; p for trend = 0.0120). Kaplan-Meier survival curves for depression symptoms severity (none, mild, moderate, and above) and adverse clinical outcomes suggested that for all but primary clinical outcomes, the cumulative risk of adverse clinical outcomes increased with increasing depression symptoms severity. ConclusionFor middle-aged and elderly hypertensive patients, depression symptoms exacerbates the risk of adverse clinical outcomes (primary outcome, all-cause mortality, CVD death, MI, HF, and non-MI ACS), and the risk increases with the severity of depression symptoms.

Correlation between plasma aldosterone concentration and bone mineral density in middle-aged and elderly hypertensive patients: potential impact on osteoporosis and future fracture risk.

Previous studies have suggested that aldosterone may play a major role in calcium-phosphorus homeostasis and bone metabolism. However, the relationship between plasma aldosterone concentrations (PAC) and bone mineral density (BMD) in middle-aged and elderly hypertensive patients remains unclear. Therefore, this study sought to investigate the relationship between PAC levels and BMD and explore PAC's potential impact on osteoporosis and future fracture risk in hypertensive patients. Our study included a total of 1430 participants. Associations are tested using multiple linear and logistic regression models. Nonlinearity was investigated using the restricted cubic spline (RCS). We also performed mediating analyses to assess mediating factors mediating the relationship between PAC and osteoporosis. The multiple linear regression showed a negative correlation between PAC and BMD and was generally positively associated with FRAX scores. Meanwhile, logistic regression analyses indicated that osteoporosis was highly correlated with PAC levels. In addition, a clear non-linear dose-response relationship was also shown in the constructed RCS model. Finally, mediation analyses showed that serum potassium played an important role in the development of osteoporosis. This study demonstrates that elevated PAC levels are strongly associated with decreased BMD, increased prevalence of osteoporosis, and the risk of future fractures in middle-aged and elderly hypertensive patients. Further studies are needed to confirm this relationship and reveal its underlying mechanisms.

Anticholinergic burden and the cognitive functions in elderly and senile patients with arterial hypertension

The aim of the study was to evaluate the effect of anticholinergic load (AHN) on cognitive functions (CF) in elderly and senile multimorbid patients with arterial hypertension (AH).Materials and methods. 330 patients aged 60 years and older with essential AH were included in the study (median age 79 [72; 84] years, 158 (51 %) of women). All the patients were underwent the assesment of CF using the Montreal Cognitive Assessment Scale (MoCA), Mini-Mental Status Scale (MMS), Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-cog), Trial Making Test (TMT), Digit Symbol Substitution Test (DSST), Verbal Association Test (literal (letter) and categorical (animal) associations), Boston Naming Test (BNT), Word-Color Interference Test, Stroop colorword conflict test. The anticholinergic load was determined using the anticholinergic load scale (Anticholinergic Cognitive Burden Scale, ACB).Results. Compared with patients who do not take anticholinergic drugs, multimorbid elderly and senile hypertensive patients with 2 or more points on the ACB scale had significantly lower final scores on the MoCA test (23 [21; 24.3] versus 24 [22; 25] points, respectively, p=0.042) and on MMSE (26 [24; 29] vs. 27.5 [25; 29] points, respectively, p=0.015), they spent statistically more time completing part B of the TMT test (217.5 [187.3; 246.3] vs. 204 [166.8; 247.3] seconds, respectively, p=0.038). The difference between the execution time of part B and part A of the TMT test in patients with 2 or more points on the ACB scale was statistically significantly greater than in patients with 0 points on this scale (141 [103.8; 168.5] versus 124 [83.8; 162] sec, respectively, p=0.034). Age, gender, education, and the structure of concomitant diseases did not differ between the groups.Conclusion. The results obtained indicate the adverse effect of аnticholinergic вurden on CF of multimorbid elderly and senile hypertensive patients and dictate the need to optimize pharmacotherapy in this category of patients.

Effect of Salt Substitution on Ambulatory Blood Pressure, Kidney Function and Inflammation in Middle-Aged and Elderly Hypertensive Patients.

Low-sodium (LS) salt substitution is recognized for its potential to reduce blood pressure (BP), but most research relies on office BP measurement (OBPM). There is a lack of data on salt substitution's effect on target organs, such as the kidney as measured by the urine albumin-to-creatinine ratio (UACR), and its impact on inflammatory cytokines, particularly high-sensitivity C-reactive protein (hs-CRP). To evaluate the effect of LS salt substitution on ambulatory BP measurement (ABPM), kidney function, and inflammation in middle-aged and elderly hypertensive patients. In this 12-month prospective, multi-center, randomized, double-blind study, 352 hypertensive patients were randomly assigned to the normal salt (NS) group (n = 176) or the LS group (n = 176) at a 1:1 ratio. ABPM, fasting blood, and morning first spot urine samples were obtained at baseline and the endpoint. Of the 352 patients, 322 completed all follow-up surveys, and 301 underwent ABPM. In the LS roup, significant reductions were observed in 24-hr systolic BP (-2.3 mmHg), 24-hr diastolic BP (-1.5 mmHg), daytime systolic BP (-2.6 mmHg), daytime diastolic BP (-1 mmHg), and nighttime systolic BP (-0.1 mmHg) compared to the NS group (all p 0.05). However, the change in nighttime diastolic BP was not statistically significant (-0.3 vs. 1.1 mmHg, p = 0.063). Additionally, the LS group showed a more substantial decrease in UACR (-2.05 vs. -7.40 µg/mg, p = 0.004) and hs-CRP (-0.06 vs. -0.24 mg/L, p = 0.048) compared to NS. LS salt substitution significantly decreased ABPM, suggesting a notable impact on hypertension. Furthermore, it demonstrated a protective impact on kidney function, as evidenced by changes in UACR. Additionally, LS salt substitution appeared to reduce inflammation, indicated by the decrease in hs-CRP levels. The study was registered in the Chinese clinical trial registry (registration number: ChiCTR1800019727).

Analysis of the Effect of Family-Centered Empowerment Model (FCEM) Health Education Through WeChat on Medication Compliance and Blood Pressure of Elderly Hypertensive Patients in Rural Areas

Objective: To validate the effectiveness of a Family-Centered Empowerment Model (FCEM) health education through WeChat on medication compliance and blood pressure among elderly hypertensive patients in rural areas. Methods: One hundred and two rural elderly hypertensive patients aged 65–80 years were selected and randomly divided into an experimental and control group of 51 each. The control group implemented conventional health education, and the experimental group implemented FCEM health education through WeChat platform for 4 consecutive weeks. The Therapeutic Adherence Scale for Hypertensive Patients (TASHP) scores and blood pressure measurements were compared between and within the two groups. Results: After the intervention, there were significant differences in medication compliance and blood pressure between the two groups (P &lt; 0.001). In the control group, before and after the intervention, there was a significant difference in medication compliance (P &lt; 0.001), but no significant difference in blood pressure (P &gt; 0.05). In the experimental group, there were significant differences in medication compliance and blood pressure before and after the intervention (P &lt; 0.001). Conclusion: The FCEM health education through an online social platform significantly improved medication compliance and led to effective blood pressure control in rural elderly hypertensive patients. Therefore, as an effective, safe, and economical model, it is also necessary to explore its effectiveness in improving health problems in other chronic diseases and other age groups.

Self-Efficacy and Quality of Life Among Farmers in Indonesia: A Literature Review

Background: The level of self-efficacy plays a role in influencing the quality of life of hypertension patients. Self-efficacy helps individuals cope with and maintain hypertension health conditions that can affect their quality of life. 55.18% of the total population in Indonesia work in the agricultural sector. Purpose: The aim of this literature review study is to explore the correlation and publications providing information on self-efficacy related to the quality of life of elderly farmers. Methods: This literature review study uses a narrative review approach and analyzes six articles from sources such as Google Scholar, ScienceDirect, and PubMed. Results: The findings suggest a significant association between self-efficacy levels and the quality of life of elderly hypertension patients in Indonesia. Hypertensive elderly farmers with high self-efficacy tend to have a better quality of life. A significant relationship was also found between self-efficacy, subjective well-being in tobacco farmers, and adherence to a healthy lifestyle among hypertension patients. Conclusion: The study concludes that factors such as gender, age, education, and life experience influence self-efficacy. Quality of life is influenced by age, education, gender, marital status, duration of hypertension, and occupation. High levels of self-efficacy are positively correlated with the ability of the elderly to face hypertension challenges and improve their quality of life. Nurses should provide education and motivation to hypertension patients to enhance their self-efficacy.

H-type Hypertension Status and Influencing Factors of the Elderly People Over 80 Years Old Based on Random Forest Model.

Hypertension is a common chronic disease in elderly people over 80 years old. Clinically, H-type hypertension occurs when hypertension coexists with hyperhomocysteinemia level of ≥ 10 umol/L. Effective identification of risk factors for H-type hypertension in the elderly can greatly improve patient prognosis.Consecutively, 494 patients with hypertension admitted to the Fourth Affiliated Hospital of Harbin Medical University from January 2019 to December 2021 were selected as the study population. They were divided into H-type hypertension (n = 197) and non-H-type hypertension groups (n = 297). Patient data were collected, including basic information, history, and clinical data. The random forest model and LASSO analysis were used to screen the influencing factors for H-type hypertension. Multiple stepwise regression analysis was used to analyze the selected variables.A total of 197 elderly people over 80 years old suffered from H-type hypertension, with an incidence rate of 39.88%. The random forest model and LASSO analysis results showed that the top 8 independent variables in importance ranking were ejection fraction (EF), fibrinogen, glycated hemoglobin (HbA1c), B-type natriuretic peptide, creatinine, fasting blood glucose, uric acid, and serum triiodothyronine levels. The results of multivariate analysis showed that EF was the protective factor, while fibrinogen, HbA1c, and creatinine were the risk factors for H-type hypertension in elderly people over 80 years old (P < 0.05).Healthcare professionals can indirectly assess the prevalence of H-type hypertension by focusing on EF, fibrinogen, creatinine, and HbA1c in elderly hypertensive patients. This provided proactive intervention and medical services to improve prognosis outcomes.