Hypertension In Elderly Population Research Articles

Effectiveness of the knowledge, attitude, practice intervention model in the management of hypertension in the elderly.

This study illustrated the effectiveness of the knowledge, attitude, practice (KAP) intervention model for community hypertension in the elderly by the community physician-led, describing the study design and baseline data. The aim of the study was to compare the changes in the elderly hypertensive population before and after the KAP intervention model by managing the elderly hypertensive patients for a period of 1 year. Basic information and risk factors affecting blood pressure control based on baseline data of recruited elderly hypertensive patients. The management approach consists of two parts: (1) the unified management of the community physician to whom the patient belongs; and (2) the management of the contracted patient by the community physician. The aim was to demonstrate the anti-hypertensive effectiveness (control rate, blood pressure reduction, and pulse pressure), the distribution of blood pressure types, and the change of the KAP in elderly hypertensive patients before and after the intervention. The KAP intervention model was administered to 2660 elderly hypertensive patients in a 1-year period. The blood pressure control rate improved by 54.03%. Mean values of overall systolic and diastolic blood pressure decreased by 16.00 and 5.31mmHg, respectively. The proportion of isolated systolic hypertension (ISH) and systolic-diastolic hypertension (SDH) decreased by 29.14% and 24.81%, respectively. The KAP compliance improved significantly. These results suggest that the community physician-led KAP intervention model is effective in the management of hypertension in the elderly.

Association of physical activity and stress reactivity with depression in elderly hypertensive population: A cross-sectional study from Eastern India.

Depressive disorder poses an increased risk for sudden cardiac death in elderly population with existing comorbidities. Also, few international studies suggest the association of decreased stress reactivity with symptoms of depression in old age. Our cross-sectional study has attempted to explore the relationship of daily exercise and stress reactivity with depression in elderly individuals with hypertension. Depression was assessed using Hamilton depression rating scale or HAM-D. The physical activity was assessed using the global physical activity questionnaire (GPAQ), developed by WHO. Stress reactivity is calculated from various cardiovascular parameters. The relationship of physical activity and stress reactivity scores on depression was explored using regression analysis. The prevalence rate of depressive symptoms in elderly hypertension population was around 40.2%. Significantly lower reactivity scores (P = 0.032) to deep breathing were evident in elderly hypertension population. After proper adjustment of the confounding factors, regression analysis depicted that decreased physical activity (Odds ratio = 4.48; 95% Confidence interval = 2.32-7.69) resulted in heavy risk of developing depressive symptoms besides old age and low educational status. Our findings suggest that low physical activity leads to the development of depressive symptoms and decreased stress reactivity among elderly hypertensive patients.

Geriatric nutrition risk index in the prediction of all-cause and cardiovascular mortality in elderly hypertensive population: NHANES 1999-2016.

Hypertension is a major risk factor for the global burden of disease, and nutrition is associated with an increased risk of mortality from multiple diseases. Few studies have explored the association of nutritional risk with all-cause mortality and cardiovascular mortality in hypertension, and our study aims to fill this knowledge gap. We included data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2016 on a total of 10,037 elderly patients with hypertension. The nutritional status was evaluated using the Geriatric Nutrition Risk Index (GNRI). Kaplan-Meier survival analysis was performed to analyze the survival rates of different nutritional risk groups. COX proportional risk regression models were used to analyze the predictive effect of GNRI on all-cause mortality and cardiovascular mortality in hypertensive patients. Restricted cubic splines (RCS) were used to explore the nonlinear relationship between GNRI and mortality. The mean age of the hypertensive patients was 70.7 years. A total of 4255 (42.3%) all-cause mortality and 1207 (17.2%) cardiovascular mortality occurred during a median follow-up period of 106 months. Kaplan-Meier showed a more significant reduction in survival for the moderate to severe malnutrition risk of GNRI. The adjusted COX proportional hazards model showed that the hazard ratios for all-cause mortality and cardiovascular mortality in the moderate to severe malnutrition risk group for GNRI were 2.112 (95% CI, 1.377,3.240) and 2.604 (95% CI, 1.603,4.229), respectively. The RCS showed that increased GNRI was associated with a reduced risk of all-cause mortality and cardiovascular mortality risk reduction. Malnutrition exposure assessed by GNRI effectively predicts the risk of all-cause mortality and cardiovascular mortality in the elderly with hypertension.

Ascending aorta dilatation reduces the influence of elevated pulse pressure on left ventricular hypertrophy: findings from a Chinese elderly hypertensive population.

To determine the role of ascending aorta dilatation in the relationship between pulse pressure (PP) and left ventricular (LV) hypertrophy. A total of 1556 Chinese elderly hypertensive patients were retrospectively studied. Transthoracic echocardiography was used to obtain the aortic and cardiac structure measurements. In addition, brachial blood pressure was measured, and total arterial compliance, systemic vascular resistance, arterial elastance, and end-systolic LV elastance were calculated. The participants were divided into four groups according to the status of ascending aortic diameter and PP. LV mass index increased in succession in the four groups, i.e., the group with the normal aorta and lower PP, with the normal aorta and higher PP, with aortic dilatation and lower PP, and with aortic dilatation and higher PP (P trend < 0.001). Total arterial compliance-1, arterial elastance, and end-systolic LV elastance were slightly higher in the individuals with normal aorta compared to those with aortic dilatation, regardless of PP being lower or higher (P < 0.01). Compared to the group with the normal aorta and lower PP, individuals with aortic dilatation had a significantly increased multivariable adjusted risk of LV hypertrophy, and higher PP further exacerbated this risk [aortic dilatation with lower PP (OR = 1.75, 95% CI: 1.01-3.04) and aortic dilatation with higher PP (OR = 3.42, 95% CI: 2.03-5.77)]. In the relation between PP and LV mass index (β = 0.095, P < 0.001), -41.3% of the total effect was attributable to mediation by ascending aortic diameter (P < 0.0001). In Chinese elderly patients with hypertension, ascending aorta dilatation could reduce the influence of elevated PP on LV hypertrophy.

Effect of Modifiable factors on Systolic Blood Pressure (SBP) in Elderly Population: A study from a tertiary care hospital in Delhi

Hypertension (HTN) is a major public health problem in all age group but isolated systolic hypertension (ISH) is the commonest form of hypertension in elderly population and it is a better predictor of cardiovascular morbidity and mortality compared to diastolic blood pressure. Aim of the present study is to evaluate the effectiveness of modifiable factors on systolic blood pressure (SBP) in elderly population on systolic blood pressure in elderly patients. This prospective observational study was conducted on the patient attending OPD &amp; IPD of HAHC Hospital, Jamia Hamdard, New Delhi. All the elderly hypertensive with elevated systolic BP were included in the study, after explaining the details about the study and taking written consent data were recorded on a proforma. The patients were followed every regularly and the effect of drugs on SBP were assessed and recoded at monthly interval. Data were analysed by using IBM SPSSv20. This study documented that among the 220 hypertensive patients who completed the study 51% were female. The maximum numbers of patients were from of age group of 56 to 65 years (44.54%). This study also shows that 40.90% patients were tobacco user. Morbidity and mortality are increased by elderly hypertension. The number of elderly hypertension patients will increase for practitioners as the US aging population rises. Most ISH in elderly hypertension. Most difficult to treat. Evidence is quite strong for treating ISH. SBP management must come before DBP reduction. Clinical studies demonstrate that lowering SBP lowers cardiovascular and renal disease more than keeping SBP uncontrolled. Prioritizing elderly SBP management is necessary.

Joint association of smoking and physical activity with mortality in elderly hypertensive patients: A Chinese population-based cohort study in 2007-2018.

BackgroundAlthough associations of physical activity and smoking with mortality have been well-established, the joint impact of physical activity and smoking on premature mortality among elderly hypertensive population was still unclear. This study aimed to assess association of physical activity, smoking, and their interaction with all-cause and cardiovascular disease (CVD) mortality risk in elderly hypertensive patients.MethodsWe included 125,978 Chinese hypertensive patients aged 60–85 years [mean (SD) age, 70.5 (6.9) years] who had records in electronic health information system of Minhang District of Shanghai, China in 2007–2015. Cox regression was used to estimate individual and joint association of smoking and physical activity on all-cause and CVD mortality. Interactions were measured both additively and multiplicatively. Additive interaction was evaluated by relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S).ResultsAmong 125,978 elderly hypertensive patients (median age 70.1), 28,250 deaths from all causes and 13,164 deaths from CVD were observed during the follow-up up to 11 years. There was an additive interaction between smoking and physical inactivity [RERI: all-cause 0.19 (95% CI: 0.04–0.34), CVD 0.28 (0.06–0.50); AP: all-cause 0.09 (0.02–0.16), CVD 0.14 (0.04–0.23); S: all-cause 1.21 (1.04–1.42), CVD 1.36 (1.06–1.75)], while the concurrence of both risk factors was associated with more than 2-fold risk of death [hazard ratio (HR): all-cause 2.10 (1.99–2.21), CVD 2.19 (2.02–2.38)].ConclusionOur study suggested that smoking and physical inactivity together may have amplified association on premature death compared to the sum of their individual associations, highlighting the importance of improving behavioral factors in combination and promoting a comprehensive healthy lifestyle in hypertensive elderly.

Assessment of hypertension in elderly population of Peshawar university

Objective: To assess hypertension in elderly people aged 60 and above residing in university campus Peshawar. Methodology: This cross-sectional study included a total of 103 elderly people aged 60 and above, selected from university campus Peshawar by simple random sampling from January to April 2019. Blood pressure was measured manually. Subjects with systolic blood pressure more than 140 and diastolic blood pressure more than 90 mm of Hg and signs &amp; symptoms of hypertension were considered as hypertensive. Semi-structured questionnaires were used to collect the data. Data was entered and analyzed on SPSS version 20 and Microsoft Excel 2013. Results: The prevalence rate of hypertension in the study population was 68.0% (70/103), which contain 41.8% (43/103) of stage I and 26.2% (27/103) of stage II hypertension. The hypertension was more prevalent in males than females. The combined mean systolic blood pressure of the total population was 146.12 mmHg (SD 21.70 mmHg, 95% CI 141.92-150.31), while mean diastolic blood pressure was 89.61 mmHg (SD 14.15 mmHg, 95% CI 86.88-92.34). Conclusion: Although prevalence of hypertension in geriatric population is very high but major bulk is undiagnosed.

Prevalence of atrial fibrillation and the risk of cardiovascular mortality among hypertensive elderly population in northeast China.

Little is known about the epidemiology and impact of atrial fibrillation (AF) on cardiovascular diseases (CVD) mortality among hypertensive elderly population in northeast China. The community‐based study included 4497 hypertensive elderly residents aged ≥65 years who lived in northeast China from September 2017 to March 2019. Information on CVD deaths was obtained from baseline until July 31, 2021. Cox proportional hazard regression models were performed in the evaluation of CVD mortality. We identified 101 persons with AF. The prevalence of AF was 2.2% among elderly hypertensive population, which increased significantly with age. The prevalence of AF was higher in men than in women. The awareness rate was 51.5%, higher in urban areas than in rural areas (68.8% vs 43.5%, P = .018). Only 4.0% patients received oral anticoagulant (OAC) therapy among AF patients. Moreover, diabetes (26.7%) and dyslipidemia (37.6%) were highly prevalent in AF patients. Furthermore, 212 persons died due to CVD (14.7/1000 person‐years) during a median follow‐up of 3.2 years. AF patients had a 3.42 (95% CI: 2.07‐5.63) times higher risk of CVD mortality than the patients without AF in the fully adjusted model. Therefore, the burden of AF among hypertensive elderly population in northeast China was considerable. Long‐term screening and management strategies for AF and related risk factors are required among hypertensive elderly in northeast China.

Epidemiological status quo of hypertension in elderly population in Changchun, China: a cross-sectional study.

ObjectivesTo investigate the epidemiological status quo of hypertension in elderly population in Changchun, China, and provide a reference for the prevention and control strategies of hypertension of elderly population in this region.DesignA cross-sectional study, as a part of a comprehensive project in Northeast China, was designed to perform in 10 districts in Changchun.Participants and settingA total of 6846 participants who were ≥60 years old were selected using a random sampling method.Main outcome measuresThe epidemiological status quo of hypertension.ResultsThe prevalence of hypertension in Changchun was 52.6%. Among participants with hypertension enrolled in this study, 87.6% of the participants had been diagnosed with hypertension before the study, 69.1% was taking antihypertensive medications and 66.9% had effective blood pressure control. Obesity, widower/widow, history of diseases and family history of hypertension were risk factors of hypertension (all p<0.05). Participants with obesity, a personal history of heart coronary disease, or a family history of hypertension were susceptible to realising risks of hypertension (all p<0.05). However, participants with diabetes, hyperlipidaemia, or a family history of hypertension were difficult to control blood pressure within the normal range (all p<0.05). In addition, 92.6% participants taking antihypertensive medications used a single medication, and calcium channel blockers was the most commonly used antihypertensive medications in monotherapy.ConclusionThe rates of awareness, treatment and control of hypertension are greater in Changchun than those in China, indicating that the prevention and control of hypertension in Changchun are effective. However, the prevalence of hypertension in the elderly population in China is lower than that in Changchun, also rendering Changchun a substantial challenge for the supervision of hypertension.

Association between sleep and prevalence of hypertension in elderly population

Objective: To explore the association between sleep duration, sleep quality and the prevalence of hypertension in the elderly aged 65 years and above. Methods: This study was conducted among the elderly in communities in Yiwu, China from April to July, 2019, and participants were recruited through physical examination in the hospital. Face-to-face interview was performed to obtain basic information. Sleep duration and sleep quality were evaluated by Pittsburgh Sleep Quality Index (PSQI). Associations between sleep duration, sleep quality and hypertension were evaluated by multivariate logistic regression analysis. Results: A total of 3 169 elderly persons, aged ≥65 years old, were included in the study. The overall prevalence of hypertension was 50.8%. The elderly with very poor sleep quality and short sleep duration accounted for 22.4% and 28.5%, respectively. After adjusting for demographic characteristics, socioeconomic status, lifestyle and health status, the OR of hypertension for the elderly with very poor sleep quality was 1.42 (95%CI: 1.12-1.80) compared with those with very good sleep quality. Compared with the elderly with sleep duration of 6-7 h a night, the OR of hypertension for those with sleep duration <6 h was 1.37 (95%CI: 1.15-1.65). As the sleep quality decreased, the risk for hypertension increased. An U-shaped association was found between sleep duration and risk of hypertension. Subgroup analyses showed that this association existed in both men and women, but only significant in the elderly aged <75 years. Conclusion: Poor sleep quality and short sleep duration were associated with risk for hypertension in the elderly.

Association Between Vascular Overload Index and New-Onset Ischemic Stroke in Elderly Population with Hypertension

BackgroundVascular overload index (VOI) is a marker of arterial stiffness and arteriolar resistance, which predicts the increasing risks of cardiovascular and cerebrovascular disease. This study aimed to evaluate the association between VOI and new-onset ischemic stroke in an elderly population with hypertension.MethodsThis retrospective cohort study included 3315 hypertensive participants aged 60 years or more. Ischemic stroke was diagnosed according to cranial computed tomography, magnetic resonance imaging of the brain or cerebrovascular angiography. The calculation of VOI was based on systolic and diastolic blood pressure. VOI was divided by quartiles (<7.88 mmHg, 7.88–16.10 mmHg, 16.10–27.14 mmHg, ≥27.14 mmHg) and evaluated the association with new-onset ischemic stroke by multivariable Cox regression models.ResultsA total of 3315 participants (55.5% female) aged 71.4±7.20 years were included in the analysis. The median follow-up period was 5.5 years, and 206 participants reached the endpoint, new-onset ischemic stroke. With per standard deviation increment in VOI, the risks of new-onset ischemic stroke increased in non-adjusted model (Hazard ratio [HR], 1.11; 95% confidence interval [CI]: 1.03–1.22; p = 0.001), adjusted model (HR, 1.11; 95% CI: 1.04–1.22; p = 0.003) and fully-adjusted model (HR, 1.15; 95% CI: 1.08–1.26; p<0.001), respectively. In multivariate fully adjusted model, the risks of ischemic stroke increased in higher quartiles in comparison to the first quartiles (p for trend <0.001).ConclusionIn an elderly hypertensive population, VOI is significantly associated with the incidence of new-onset ischemic stroke. Elevated VOI is the cardiovascular risk factor and increases the probability of new-onset ischemic stroke.

Blood Pressure is Associated with Rapid Kidney Function Decline in a Very Elderly Hypertensive Chinese Population.

PurposeIn prior analyses, blood pressure (BP) was related to rapid kidney function decline (RKFD). However, studies of this relationship in populations of advanced age are lacking. In the present study, we therefore examined the relationship between BP and RKFD in a population of 284 hypertensive Chinese individuals over the age of 80.Patients and MethodsAll study participants were diagnosed with hypertension (systolic BP [SBP] 160–200 mmHg; diastolic BP [DBP] <110 mmHg). RKFD was defined based upon a decline in estimated glomerular filtration rate (eGFR) >5mL/min per 1.73 m2 per year during follow-up. The Cox regression models (competing risk models) were used for calculating hazard ratios (HRs) to examine the relationship between SBP, DBP, pulse pressure (PP) and RKFD.ResultsOver a 3.3-year median follow-up period, 68 study participants (23.9%) were diagnosed with RKFD, while 35 (12.3%) died. After adjusting for confounding variables, we determined that each 10 mmHg rise in SBP and PP was associated with a 34% and 110% increase, respectively, in RKFD risk (adjusted HR: 1.34, 95% confidence interval [CI]: 1.05–1.71 for SBP, p=0.02; HR: 2.10, 95% CI: 0.87–5.08 for PP, p=0.10). In addition, we determined that each 10 mmHg increase in DBP was linked to a 10% reduction in RKFD risk (adjusted HR: 0.90, 95% CI: 0.70–1.14, p=0.37).ConclusionOur results indicate that SBP, but not DBP or PP, is positively correlated with RKFD risk in a very elderly hypertensive Chinese population.

Association between pulse pressure and ischaemic stroke in elderly patients with hypertension

BackgroundThe association between pulse pressure (PP) and the risk of first ischaemic stroke (IS) is inconsistent. Therefore, we evaluated the association between PP and the risk of first IS among...

Prevalence, awareness, treatment and control of hypertension in elderly residents in Hebei province

Objective: To understand the prevalence, awareness, treatment and control of hypertension in elderly residents in Hebei province. Methods: Elderly residents aged ≥60 were selected though multistage clustering sampling during August to December, 2015. Design based methods were adopted to analyze the prevalence, awareness, treatment and control of hypertension in local residents of Hebei. Results: A total of 2 501 elderly adults were included in the study. The overall prevalence rate of hypertension was 63.7% (58.3% in males, 69.0% in females), the awareness rate of hypertension was 42.4% (35.7% in males, 48.0% in females), the treatment rate was 38.2% (32.0% in males, 43.3% in females), and the control rate was 9.0% (8.1% in males, 9.7% in females). The results of multivariate analysis indicated that age, sex, degree of education, BMI and central obesity were the factors influencing the prevalence, awareness, treatment and control of hypertension in elderly population in Hebei. Conclusions: The prevalence of hypertension was high, but the rates of awareness, treatment and control of hypertension were low in elderly residents in Hebei. The influences of overweight, obesity and central obesity on hypertension were significant in the elderly. It is necessary to standard the management of hypertension and reduce the risk factors for hypertension in elderly population to improve the control of hypertension.

Different anthropometric indices and incident risk of hypertension in elderly population: a prospective cohort study

Objective: To explore the relationship between anthropometric indices and the incident risk of hypertension, compare novel anthropometric indices with traditional indices in hypertension prediction and establish hypertension prediction models among elderly Chinese. Methods: A total of 27 009 retirees from the Dongfeng Motor Corporation were recruited at baseline in 2008 and the first follow-up was conducted in 2013. After the exclusion of participants less than 60 years old, participants with hypertension, coronary heart disease, stroke, cancer, and those with missing data, a total of 6 784 elderly participants were enrolled in this study. A multivariate logistic regression model was used to analyze the relationship between traditional anthropometric indices, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), novel anthropometric indices, visceral adiposity index (VAI), body shape index (ABSI), body roundness index (BRI), and the incident risk of hypertension. Meanwhile, a multivariate logistic regression model was used to establish hypertension prediction models. Receiver operating characteristic (ROC) curve was applied to compare the prediction ability of different models. Results: A total of 1 787 incident cases of hypertension were identified, with the incidence of hypertension about 27.59%. Significant positive associations were detected between BMI, WC, WHtR, VAI, BRI and the incident risk of hypertension after adjusting for potential confounders (all P values<0.05). In men, the OR (95%CI) (upper tertile vs lower tertile) was 1.45 (1.22-1.73) for VAI, and 1.86 (1.55-2.23) for BRI. In women, the OR (95% CI) (upper tertile vs lower tertile) was 1.55 (1.22-1.96) for VAI, and 1.60 (1.27-2.01) for BRI. For ABSI, no significant association was observed in either men (OR (95%CI): 1.07 (0.90-1.28)) or women (OR (95%CI): 1.03 (0.82-1.29), both P values >0.05). The basic hypertension prediction model included age, drinking (only in men), education status (only in men), systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood glucose levels. Based on the basic prediction model, BMI (in men: AUC=0.697) and BRI (only in men: AUC=0.696) improved area under ROC curve (AUC) significantly (P<0.05). BMI was the strongest predictor in both men (AUC=0.697) and women (AUC=0.685) in the extended model. Conclusion: Significant positive associations were detected between BMI, WC, WHtR, VAI, BRI and the incident risk of hypertension among elderly Chinese. BMI was the strongest predictor in hypertension prediction model compared with other anthropometric indices.

A7625 Change in blood pressure variability among elderly treated hypertensive population and its association with mortality

Objectives: Higher blood pressure variability (BPV) is associated with increased cardiovascular and all-cause mortality. We aimed to explore whether BPV changed overtime in response to treatment and whether such change (decline/increase) has any association with long-term mortality amongst an elderly hypertensive population. Methods: We used data from a subset of Second Australian National Blood Pressure study participants (n = 496) aged ≥65 years who had 24 hours ambulatory BP (ABP) recording at study entry (baseline) and then after a median 2-yrs while on-treatment (follow-up). Weighted 24hr systolic BPV was calculated for both baseline and follow-up as a weighted mean of daytime and nighttime BP records standard deviations (SD). The annual rate of change in BPV over-time was calculated from these BPV estimates. Further, we classified both BPV estimates into ‘high’ and ‘low’ based on the baseline median BPV value; and then classified BPV changes into ‘No-change: low’, ‘no-change: high’, ‘decline: high to low’ and ‘increase: low to high’. Association of BPV changes with mortality outcome was assessed over a median 8.5 years after the follow-up ABPM. Results: We observed a decline in average weighted 24hr systolic BPV (mmHg) between baseline (11.8 ± 2.9) and follow-up (11.2 ± 3.2) among the study cohort. The observed BPV annual decline rate (mean ± SD) was –0.78 ± 1.95 (range –7.36 to 9.87). Having a ‘high’ BPV at baseline was associated after adjustment with an increase in all-cause and cardiovascular mortality irrespective of any change in BPV (Table 1). For those with ‘low’ BPV at baseline was not associated with an increase in mortality. Conclusion: In Elderly hypertensives having BPV above baseline median was associated with increased long-term mortality irrespective of any change in BPV.

Visit-to-visit (long-term) and ambulatory (short-term) blood pressure variability to predict mortality in an elderly hypertensive population.

To explore the association of different types of blood pressure (BP) variability measures estimated from either short-term ambulatory reading-to-reading or long-term clinic visit-to-visit BP records with long-term survival in an elderly treated hypertensive population. A subset of patients (n = 508) aged at least 65-years was studied from the Second Australian National Blood Pressure study. We estimated SBP and DBP BP variability as the SD of ambulatory (24-h, daytime, night-time) and clinic visit-to-visit BP directly from all corresponding on-treatment within-individual BP records. Ambulatory 'weighted day-night' variability was calculated as a weighted mean of daytime and night-time SD. Cox-proportional hazard models adjusted for baseline risk factors (Model 1) and corresponding on-treatment BP (Model 2) or average night-time SBP (best predictive BP measure for outcome) (Model 3) were used to determine the relationship between long-term outcome and BP variability. Over a median of 10.6 years, 101 patients died from any cause, of which 51 deaths were cardiovascular. We observed increase in 'daytime' and 'weighted day-night' SBP/DBP variability was significantly associated with increased all-cause mortality in all models. For cardiovascular mortality, only 'weighted day-night' SBP variability significantly predicted risk in all models (Model 3 hazard ratio: 1.09, 95% confidence interval: 1.00-1.19, P = 0.04). Long-term BP variability was not associated with any outcome. On direct comparison, both 'daytime' and 'weighted day-night' BP variability measures provided similar prognostic information. Short-term 'daytime' and 'weighted day-night' SBP variability from ambulatory BP recordings was a better predictor of mortality in elderly treated hypertensive patients than long-term BP variability from visit-to-visit BP recordings.

A Sympathetically Mediated α1‐Adrenoceptor Dependent Pathway Promotes Renal Sodium Chloride Cotransporter Activity in Age‐Related Hypertension

AimHypertension is positively correlated with age and sympathetic tone in human subjects. These studies tested the hypothesis that sodium chloride cotransporter (NCC)‐mediated sodium retention and sympathoexcitation contribute to age‐related hypertension.MethodsThree‐month, 8‐month, and 16‐month old male Sprague‐Dawley (SD) rats underwent one of three studies. In the first study, MAP, HR, NCC activity (peak natriuresis to IV hydrochlorothiazide, HCTZ, 2 mg/kg), and measures of sympathetic tone [peak depressor response to IV hexamethonium (30 mg/kg), and plasma and renal norepinephrine (NE) levels] were assessed. In the second study, renal histology was evaluated and total protein expression of the NCC, with‐no‐lysine 1 (WNK1), and STE‐20 Alanine/Proline kinase (SPAK), and phosphorylated SPAK/oxidative stress response 1 (OxSR1) normalized to β‐actin was assessed in renal cortical tissue. In the third study, rats underwent chronic antagonism of the NCC (s.c. HCTZ, 4 mg/kg/d, 14d) or α1‐adrenoceptors (s.c. terazosin, 10 mg/kg/d, 14d) and MAP, HR, and NCC activity were assessed (n=4–5/group).ResultsBasal MAP and NCC activity increased with age (MAP [mmHg]; 3‐month 124±2 vs 8‐month 140±1 vs 16‐month 149±3, P&lt;0.05: peak ΔUNaV to HCTZ [μeq/min]; 3‐month 9±1 vs 8‐month 18±2 vs 16‐month 15±5, P&lt;0.05). Measures of sympathetic activity, including global and renal NE levels and peak depressor response to hexamethonium, also increased with age (plasma NE [nmol/L]; 3‐month 44±4 vs 8‐month 55±3, P&lt;0.05: renal NE [pg/mg]; 3‐month 612±36 vs 8‐month 835±48 vs 16‐month 974±39, P&lt;0.05: peak depressor response to hexamethonium [mmHg]; 3‐month −33±4 vs 8‐month −64±5 vs 15‐month −60±3, P&lt;0.05).Renal cortical expression of total WNK1 and phosphorylated SPAK/OxSR1 increased with age (WNK1 [ODU/mm2]; 3‐month 0.49±0.07 vs 8‐month 0.62±0.05 vs 16‐month 0.78±0.08, P&lt;0.05: pSPAK/OxSR1 [ODU/mm2]; 3‐month 0.81±0.1 vs 8‐month 0.95±0.14 vs 16‐month 1.37±0.17, p&lt;0.05). Total NCC, SPAK, and OxSR1 expression did not change with age. No gross changes in renal histology were observed in aging rats.Chronic α1‐adrenoceptor antagonism abolished the age‐related increase in NCC activity and attenuated age‐related hypertension (peak ΔUNaV to HCTZ [μeq/min]; 16‐month 15±5 vs. s.c. terazosin 10±3, P&lt;0.05: MAP [mmHg]; 16‐month 149±3 vs s.c. terazosin 134±4, P&lt;0.05). Chronic NCC antagonism attenuated age‐related hypertension (MAP [mmHg] 16‐month 149±3 vs s.c. HCTZ 136±5, P&lt;0.05).ConclusionAge‐related hypertension is accompanied by global and renal sympathoexcitation and increased renal NCC activity. We speculate that in aged animals, elevated sympathetic tone increases NE‐driven renal NCC activity via an α1‐adrenoceptor‐WNK1‐SPAK/OxSR1 dependent pathway, promoting NCC‐mediated sodium reabsorption and the development of age‐related hypertension. Our data suggest that therapies targeting renal sympathetic outflow and α1‐adrenoceptors may be particularly well suited to the elderly hypertensive patient population.Support or Funding InformationThis work was supported by NIH grants R01HL107330 and K02HL112718 and AHA grants 16MM32090001 and AHA17GRNT3367002 to RDW and NIH grant F31DK116501 to AAF.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Long-term survival following the development of heart failure in an elderly hypertensive population.

Available data on the prognosis of heart failure (HF) patients are predominantly limited to patients diagnosed at time of hospitalization. To describe the long-term survival of incident HF patients and identify clinical characteristics associated with mortality. The Second Australian National Blood Pressure Study (ANBP2) randomized 6083 hypertensive subjects aged 65-84years to angiotensin-converting enzyme (ACE) inhibitor or thiazide diuretic-based therapy and followed them for a median of 4.1years. One hundred forty-five participants who developed HF and 5938 who remained free from HF during the trial period were followed for a median of 6.7years during a posttrial follow-up. Three quarters, 110 (76%) of HF patients had died at the end of the follow-up. The five- and ten-year survival rates following HF diagnosis during the trial period were 37% and 15%, respectively, in men, compared with 60% and 33%, respectively, in women. In non-heart failure participants, the five- and ten-year survival rates, following enrollment into the study, were 92% and 76%, respectively. Mortality following HF diagnosis increased with advancing age (HR=1.09, 95% CI: 1.04-1.33). In addition, male gender and preexisting diabetes were predictive of mortality, while ACE inhibitor-based therapy for the initial trial was associated with 39% decrease (HR=0.61, 95% CI: 0.41-0.91) in mortality compared with a thiazide diuretic-based regimen. Long-term survival in elderly HF patients is poor, especially in men. Mortality in HF patients increased progressively with advancing age, while allocation to the ACE inhibitor-based regimen for the initial trial significantly improved HF outcome.

Pet ownership and survival in the elderly hypertensive population.

To assess the association of pet ownership and all-cause and cardiovascular mortality over a long-term follow-up among elderly treated hypertensive participants. Pet-ownership data from a subcohort of the Second Australian National Blood Pressure study were used. Participants were aged 65-84 years at enrolment (1995-1997) and responded to a pet-ownership questionnaire during year 2000. Participants' survival information was determined over a median of 10.9 years that includes Second Australian National Blood Pressure in-trial period (median 4.2 years) together with posttrial follow-up period (median 6.9 years). For the current study, end points were any fatal cardiovascular event and all-cause fatal events. Of those who responded to a pet-ownership questionnaire (4039/6018 - 67%), 86% (3490/4039) owned at least one pet at any-time during their life (current or previous pet owner), with 36% (1456/4039) owning at least one pet at the time of the survey. During the follow-up period, 958 participants died including 499 deaths of cardiovascular origin. Using a Cox proportional hazard regression model adjusting for possible confounders, there was a 22 and 26% reduction in cardiovascular mortality observed among previous and current pet owners, respectively, compared with those who had never owned one. A similar nonsignificant trend was observed for all-cause mortality once adjusted for potential confounders. Pet ownership was associated with an improved cardiovascular disease survival in a treated elderly hypertensive population.