Hypertension In Older Patients Research Articles

Clinical and pharmacological management of hypertension in older patients

The article is presented the review of published sources devoted the strategy of treatment the older patients with hypertension according to the geriatric symptoms and syndromes. The definition of orthostatic and postprandial hypotension, hypotension-hypertension syndrome is shown. Based on the analyses of publication are taken the data related to prevalence, prognostic meaning, clinical outcomes of frailty in older people. The influence of geriatric signs on cardiovascular risk is pointed out. The discussion questions of the association between administration of medications and orthostatic hypertension in older patients are considered. The recommendations of optimal pharmacological management of hypertension in older patients into account of personification principles with assessment of aging changes and their dynamics during treatment are given.

Current practice toward the use of antihypertensive agents in the management of hypertension – A cross-sectional study among Indian physicians

Objective: The objective of this study was to assess current practices and usage patterns of antihypertensive medications in managing hypertension (HTN) in India. Materials and Methods: A cross-sectional, observational digital study was conducted among health-care practitioners (HCPs) across India (November 2022–March 2023). Results: A total of 792 HCPs (cardiologists, consulting, and general physicians) participated in this study. According to 63.38% of HCPs, 20–50 essential HTN patients seek consultation weekly. The majority of patients were in the age range of 40–60 years (84.09%). A total of 67.55% of HCPs mentioned that systolic blood pressure (BP) ranged between 140 and 160 mmHg. Type 2 diabetes mellitus was the most common comorbidity among hypertensive patients (84.09%). In total, 53.79% and 37.37% of HCPs preferred angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme and calcium channel blockers (CCBs) as the first choice of antihypertensive agents. The majority of HCPs (>69%) preferred prescribing a triple-drug fixed-dose combination (FDC) of CCBs + ARB + diuretics in hypertensive patients with coronary artery disease (CAD) and resistant HTN. The majority (89.90%) of HCPs preferred prescribing FDC of CCBs over monotherapy. Amlodipine (>55%) followed by cilnidipine (>32%) were preferred CCBs for young and older hypertensive patients. In patients with essential HTN without any CVD, amlodipine (72.85%) was the preferred CCB. Vascular selectivity (59.09%) and longer half-life (54.55%) were important factors for prescribing CCBs. Resistant HTN, inadequate BP control with monotherapy, and the presence of CAD were all (62.63%) important considerations for FDC with CCBs. The underutilization of CCBs in managing HTN (63.88%) was highlighted. Conclusion: Overall responses provide a comprehensive overview of the prevailing perception and the usage patterns of antihypertensive agents employed by HCPs in India.

Abstract 114: Effect Of Dose Of Chlorthalidone And Hydrochlorothiazide Dosing On Cardiovascular Outcomes In The Diuretic Comparison Project (DCP)

Background: The Diuretic Comparison Project (DCP) showed chlorthalidone (CTD) to be comparable with hydrochlorothiazide (HCTZ) in cardiovascular prevention among older hypertensive patients. Previous hypertension outcome trials showing benefit for either, higher doses of each were predominant. DCP randomized 13,523 participants to stay on existing HCTZ (25/50mg) or switch to a dose equivalent CTD (12.5/25mg). Such trial data was used to test if CTD was superior to HCTZ when prescribed at a higher dose. Methods: This analysis examined treatment effects with respect to low (25mg HCTZ/12.5mg CTD) and high (50mg HCTZ/25mg CTD) dose regimens. Outcomes including non-fatal MI, stroke, acute heart failure, revascularization for unstable angina and non-cancer death were tested individually and as a composite measure. Results: There were no differences for the composite and all individual outcomes in both low dose (12,781/13,523; 94.5%) and high dose (742/13,523; 5.5%) groups. Mean age (72 y), baseline blood pressure (139 mm Hg), and follow-up time (2.4 y) were similar across doses. High dose participants had a greater prevalence of diabetes and received more antihypertensive drugs. Consistent with DCP results, there was a significant interaction between treatment group and history of MI/stroke in the low dose group (p=0.002); this was not found in the high dose group (p=0.8). Conclusion: As in the main DCP trial results, there were no differences in outcomes between CTD and HCTZ within higher or lower dose subgroups. Treatment interaction with prior mi/stroke was found with lower doses. However, the high dose group was small and might not reflect a true treatment effect at higher doses.

Differences in Cardiovascular Regulation to Head-up Tilt between Healthy and Hypertensive Subjects.

To date there have only been limited studies exploring abnormal hemodynamic responses to head-up tilt tests (HUTs) in elderly, treated patients with hypertension. Cardiovascular regulation in response to HUT as well as upright hemodynamics may be altered when older hypertensive patients with antihypertensive treatments are studied. Hypertensive patients with and without receiving antihypertensive medication and above the age of 45 were recruited in this study. This study compared the cardiovascular responses to HUT and at rest between healthy and hypertensives using non-invasive hemodynamic measurements. Parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), stroke index (SI) and total peripheral resistance index (TPRI) were measured in 40 subjects (20 healthy and 20 hypertensives) for 10-min supine baseline, 10-min HUT at 70◦ and 6-min supine recovery. At rest and during HUT, SBP and TPRI were significantly higher in hypertensives together with a significantly smaller baseline SI. In response to HUT, both groups showed changes in hemodynamic parameters at differing degrees. During recovery, all parameters returned to the baseline range. Our findings indicated that hypertensive patients of older age being treated by antihypertensive drugs may have different cardiovascular changes in response to orthostatic stress.Clinical Relevance- This pilot study describes how cardiovascular regulation in response to postural change may behave differently in hypertensive elder patients taking antihypertensive drugs.

First-line diuretics versus other classes of antihypertensive drugs for hypertension.

First-line diuretics versus other classes of antihypertensive drugs for hypertension.

COVID-19 and the Use of Angiotensin II Receptor Blockers in Older Chronic Hypertensive Patients: Systematic Review and Meta-Analysis.

Angiotensin II-converting enzyme inhibitors (ACEIs) and selective angiotensin II receptor antagonists (ARAIIs) are widely used antihypertensive agents. Their use has generated controversy due to their possible influence on the health status of chronic patients infected with COVID-19. The objective of this work is to analyze the influence of COVID-19 on chronic hypertensive patients treated with ACEI and ARAII inhibitors. A systematic review and meta-analysis in the databases Pubmed, Pro-Quest and Scopus were carried out. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search equation descriptors were obtained from the Medical Subject Headings (MeSH) thesaurus. The search equation was: "Older AND hypertension AND (COVID-19 OR coronavirus) AND primary care" and its equivalent in Spanish. Nineteen articles were obtained, with n = 10,806,159 subjects. Several studies describe the COVID-19 association with ACEI or ARAII treatment in hypertension patients as a protective factor, some as a risk factor, and others without a risk association. In the case of ACEI vs. ARAII, the risk described for the former has an odds ratio (OR) of 0.55, and for ARAII, an OR of 0.59. Some authors talk about mortality associated with COVID-19 and ACEI with a half ratio (HR) of 0.97, and also associated ARAIIs with an HR of 0.98. It is recommended to maintain the use of the renin-angiotensin-aldosterone axis in the context of the COVID-19 disease.

A Study on the Evaluation of Serum Uric Acid in Patients with Essential Hypertension

ABSTRACT Background: Hyperuricemia can lead to nephrolithiasis and gout. It is an essential indicator of diseases like metabolic syndrome, cardiovascular disease, diabetes mellitus, and chronic renal disease. It indicates that hyperuricemia is associated with the risk of cardiorenal disease and new-onset hypertension. In older hypertensive patients, hyperuricemia is an essential indicator of cardiovascular risk for the development of hypertension. Methodology: A facility-based case-control study to identify the relationship between serum uric acid levels and hypertension, the relation between severity and duration of hypertension and the serum uric acid levels, and the relation between duration of hypertension and serum uric acid levels at tertiary care hospital. Sample size: 400; 200 cases and 200 controls. Adult male and female patients >18 years of age diagnosed as hypertensive according to JNC VII classification for hypertension were included. Patients with comorbidities are excluded. The method of uric acid estimation was done by the VITROS URIC Slide method. Results: The mean total cholesterol of cases was 159.18 ± 20.16, and controls were 125.21 ± 21.12. The mean high density lipoproteins (HDL) among cases was 36.33 ± 5.08, and controls were 45.64 ± 5.90. The mean low density lipoproteins (LDL) among cases was 124.99 ± 20.03, and controls were 104.48 ± 12.48. The mean triglycerides among cases was 172.58 ± 31.40, and controls were 131.21 ± 21.50. The mean serum uric acid level among males in the cases group was 6.1 ± 1.79, and among males in the control group, it was 5.2 ± 1.3. The mean serum uric acid level among females in the case group was 6.2 ± 1.92, and among the control group, it was 5.3 ± 1.1. The unpaired t-test was used and was statistically significant with a P value < 0.0001 among the above parameters. Conclusion: The study had a direct relationship between hyperuricemia and hypertension. Also, there is a positive correlation between the severity of hypertension and serum uric acid levels and higher hypertension of longer duration when compared to lesser duration.

AVERAGE ACHIEVED BP <130/80 MMHG IN HIGH-RISK MIDDLE-AGED AND OLDER HYPERTENSIVE PATIENTS PROVIDES STRONG CARDIOVASCULAR PROTECTION EXCEPT IN LEFT VENTRICULAR HYPERTROPHY

Objective: Evidence that reducing blood pressure (BP) to <130/80 mmHg rather than to <140/90 mmHg by antihypertensive treatment in hypertensive patients is conflicting. Left ventricular hypertrophy (LVH) is common in hypertension, and low perfusion pressure may result in ischemia in patients with LVH. We investigated whether average achieved BP <130/80 mmHg implied cardiovascular benefits in high-risk middle-aged and older hypertensive patients who participated in the VALUE Trial. Considering a previous report of excess mortality in LVH patients with in-treatment systolic BP (SBP) <130 mmHg, we paid special attention to whether the average achieved SBP <130 mmHg may cause harm in similar patients with LVH. Design and method: Of the 15,245 participants, we identified 13,803 patients without cardiovascular events during the first six months after randomization during which previous medications were discontinued and study drugs up-titrated. Of these, 2,458 patients had LVH on an electrocardiogram (ECG). Cox analyses adjusted for age, gender, and baseline variables compared cardiac and all-cause mortality and other pre-specified endpoints for patients who achieved average SBP 130 - 139 mmHg (No LVH group n = 4,863, ECG LVH group n = 929) and <130 mmHg (No LVH group n = 2,107, ECG LVH group n = 305). Reference groups were patients who achieved an average SBP > = 140 mmHg following the first excluded six months (No LVH group n = 4,375, ECG LVH group n = 1,224). Results: The No LVH group with average achieved BP <130/80 mmHg had a significantly lower incidence of all endpoints except for myocardial infarction. The ECG LVH group with average achieved SBP <130 mmHg had increased cardiac mortality (HR = 1.98, p = 0.032) and all-cause mortality (HR = 1.74, p = 0.007), and SBP <130 mmHg was not associated with a reduction in any endpoint. However, as in those without LVH, the ECG-LVH group had fewer strokes and heart failure with an average achieved diastolic BP <80 mmHg. Conclusions: Our data suggest that target SBP <130 mmHg may cause harm and needs further investigation in middle-aged and older patients with LVH detected by ECG. Otherwise, the average achieved BP <130/80 mmHg prevents most cardiovascular endpoints in middle-aged and older hypertensive patients with high cardiovascular risk but without LVH.

Intensive Blood Pressure Lowering Improves Left Ventricular Hypertrophy in Older Patients with Hypertension: The STEP Trial.

Intensive systolic blood pressure (SBP) lowering has been increasingly used; however, its effect on cardiac remodeling remains not fully understood. This secondary analysis of the Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients trial aims to determine the changes in left ventricular hypertrophy (LVH) that occur in the context of intensive SBP lowering. A total of 7141 older patients with hypertension were randomly assigned to intensive treatment (SBP target, 110-130 mm Hg) or standard treatment (130 to 150 mm Hg). LVH was defined according to the Peguero-Lo Presti criteria on a standard 12-lead ECG. At baseline, the prevalence of LVH (16.6% versus 16.5%) and the mean Peguero-Lo Presti value (1811 versus 1808 μV) were comparable between the treatment groups. During a median follow-up of 3.24 years, intensive SBP lowering was associated with a significantly lower risk of new LVH occurrence (hazard ratio, 0.76 [95% CI, 0.66-0.89]; P=0.001) and slower progression of the mean Peguero-Lo Presti index value by -23.47 μV/y (95% CI, -34.93 to -12.01; P=0.000). However, the rates of regression of baseline LVH did not differ significantly. Of note, the beneficial effect of intensive SBP lowering in terms of cardiovascular events (hazard ratio, 0.75 [95% CI, 0.59-0.97]) was not markedly attenuated after adjusting for LVH as a time-varying covariate (hazard ratio, 0.76 [95% CI, 0.59-0.97]). Intensive SBP lowering protects against LVH development in older hypertensive patients, however, this favorable effect could not explain most of the reduction in cardiovascular events associated with intensive SBP lowering.

Left Ventricular Hypertrophy and Clinical Outcomes in Heart Failure Patients Based on Hypertension Subtypes: Insights from a Tertiary Hospital Heart Failure Registry in Malang, Indonesia

Background Left ventricular hypertrophy (LVH) is a maladaptive response to chronic pressure overload and an important risk factor sudden death in patients with heart failure. Previous studies show that LVH is a risk factor for systolic heart failure. It’s interesting to examine whether Isolated Systolic Hypertension (ISH) in the presence of LVH contribute to clinical outcome. Objective: The aims of this study to examined association of ISH with cardiovascular outcomes and to examined associations of ISH and LVH in Heart failure registry patient Methods: A total of 120 subject’s were collected from Saiful Anwar Heart Failure Registry from January 2019 to December 2019. All participants were individually interviewed with a structured questionnaire for collecting baseline characteristic. Subject were classified into 2 group of hypertension (ISH and Systolic Diastolic Hypertension (SDH)). ISH based on the criteria of SBP ≥ 140 and DBP < 90 mmHg and SDH based on SBP ≥ 140 and DBP ≥ 90 mmHg. The EF and volumes were measured with 2D-biplane Simpson's method by measured as a standart manner Result’s: ISH commonly found among older hypertensive patients than SDH (Mean age 61,23±11,2 yo vs 53,52±11,1 yo, respectively, p<0,04)). LVH was more prevalence among ISH than SDH. No difference in clinical outcome such as in hospital mortality, Rehospitalization, and Lengt of stay were observed in both groups. Complication of hypertension was similar in both groups such as stroke, Myocardial Infarct, and Chronic Kidney Disease. Intrestingly, no difference also observe in compliance to the drug between ISH and SDH. We also examined subgroup analysis of subject’s with ISH. There was no statistically significant difference in clinical outcome between ISH with LVH and ISH without LVH. Conclusion: In this study, we suggest that ISH more common in older patient with HF than SDH but had similar associations with cardiovascular mortality and rehospitalization. ISH was associated with a higher prevalence of left ventricular hypertrophy than SDH.

Intensive versus standard blood pressure control in older persons with or without diabetes: a systematic review and meta-analysis of randomised controlled trials.

To assess and compare the benefits and harms of intensive versus standard blood pressure (BP) control in older people with or without diabetes mellitus (DM). Systematic review and meta-analysis. Randomised controlled trials comparing intensive versus standard BP control, identified from MEDLINE, Embase, The Cochrane library, Web of Science and a search of bibliographies from inception till August 2022. Older people (≥65 years) with or without DM. Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for adverse vascular and safety outcomes. We included six randomised controlled trials (RCTs) comprising 20,985 patients (intensive BP = 10,474 and standard BP = 10,511) with a weighted mean follow-up of 3.1 years. In the general population, the RRs (95% CIs) of intensive versus standard BP control for composite cardiovascular events or major adverse cardiovascular events (CVD/MACE), CVD mortality, coronary heart disease, stroke and heart failure were 0.71 (0.62-0.82), 0.65 (0.49-0.86), 0.75 (0.60-0.95), 0.75 (0.61-0.92) and 0.58 (0.41-0.82), respectively. Intensive BP control did not increase the risk of renal failure or serious adverse events in the general population. Two RCTs reported results for composite CVD/MACE in patients with DM with a pooled estimate of 0.85 (0.67-1.07). Aggregate trial evidence shows that intensive BP control (<120 to <140 mmHg) reduces the risk of adverse cardiovascular outcomes in older hypertensive patients in the general population with no increase in adverse events. Intensive BP control may confer similar benefits for older patients with DM with no evidence for harm, but this is based on limited data.PROSPERO Registration: CRD42022349791.

Effects of intensive vs. standard blood pressure control on cognitive function: Post-hoc analysis of the STEP randomized controlled trial.

The STEP (Strategy of Blood Pressure Intervention in the older Hypertensive Patients) trial showed that intensive systolic blood pressure (SBP) control resulted in a lower incidence of cardiovascular events than standard treatment. This study analyzed the effects of intensive SBP lowering on cognitive function. STEP was a multicenter, randomized controlled trial of hypertensive patients aged 60-80 years. Participants were randomly assigned (1:1) to SBP goals of 110-130 mmHg (intensive treatment) or 130-150 mmHg (standard treatment). Each individual was asked to complete a cognitive function test (Mini-Mental State Examination; MMSE) at baseline and during follow-up. The primary outcome for this study was the annual change in MMSE score. Subjects with a score less than education-specific cutoff point were categorized as cognitive decline. The analysis enrolled 6,501 participants (3,270 participants in the intensive-treatment and 3,231 participants in the standard-treatment groups). Median follow-up was 3.34 years. There was a minor change in MMSE score, with an annual change of -0.001 [95% confidence interval [CI] -0.020, 0.018] and 0.030 (95% CI 0.011, 0.049) in the intensive- and standard-treatment groups, respectively (p = 0.052). Cognitive decline occurred in 46/3,270 patients (1.4%) in the intensive-treatment group and 42/3,231 (1.3%) in the standard-treatment group (hazard ratio 0.005, 95% CI 0.654, 1.543, p = 0.983). Compared with standard treatment, intensive SBP treatment did not result in a significant change in cognitive function test score. The impact of intensive blood pressure lowering was not evident using this global cognitive function test. ClinicalTrials.gov. Unique identifier: NCT03015311.

Pathways linking relative deprivation to blood pressure control: the mediating role of depression and medication adherence among Chinese middle-aged and older hypertensive patients

BackgroundStudies have demonstrated that individuals of low socioeconomic status have higher blood pressure. Yet, whether socioeconomic inequality would influence blood pressure control and the underlying mechanisms associated with socioeconomic inequality in blood pressure control are unknown. Central to socioeconomic inequality is relative deprivation. We aim to examine the association between relative deprivation and blood pressure control and to investigate the pathways of the association among middle-aged and older adults with hypertension.MethodsData were collected from the 2020 Household Health Interview Survey in Taian City, Shandong province. This study included 2382 eligible respondents aged 45 years and older with a diagnosis of hypertension. Our primary outcome was dichotomous blood pressure control. Relative deprivation was calculated with the Deaton Index. Depressive symptoms and medication adherence were considered as mediators. Multivariable binary logistic regression models were used to estimate the effect of relative deprivation on blood pressure control. The “KHB-method” was used to perform mediation analysis.ResultsAmong 2382 middle-aged and older adults with hypertension, the mean age was 64.9 years (SD 9.1), with 61.3% females. The overall proportion of participants with uncontrolled blood pressure was 65.1%. Increased relative deprivation was likely to have higher odds of uncontrolled blood pressure (OR: 2.35, 95%CI: 1.78–7.14). Furthermore, depressive symptoms and medication adherence partially mediated the overall association between relative deprivation and blood pressure control, with depressive symptoms and medication adherence explaining 5.91% and 37.76%, respectively, of the total effect of relative deprivation on blood pressure control.ConclusionsIndividual relative deprivation could threaten blood pressure control among middle-aged and older hypertension patients through the mechanisms of depression and medication adherence. Hence, improving blood pressure control may require more than just health management and education but fundamental reform of the income distribution and social security system to narrow the income gap, reducing relative economic deprivation. Additionally, interventions tailoring psychological services and medication adherence could be designed to reduce the harmful effect of relative deprivation on blood pressure control among disadvantaged individuals.

Medical Telemonitoring for the Management of Hypertension in Older Patients in Japan.

Hypertension is the most frequent modifiable risk factor associated with cardiovascular disease (CVD) morbidity and mortality. Even in older people, strict blood pressure (BP) control has been recommended to reduce CVD event risks. However, caution should be exercised since older hypertensive patients have increased physical vulnerability due to frailty and multimorbidity, and older patients eligible for clinical trials may not represent the general population. Medical telemonitoring systems, which enable us to monitor a patient's medical condition remotely through digital communication, have become much more prevalent since the coronavirus pandemic. Among various physiological parameters, BP monitoring is well-suited to the use of such systems, which enable healthcare providers to deliver accurate and safe BP management, even in the presence of frailty and/or living in geographically remote areas. Furthermore, medical telemonitoring systems could help reduce nonadherence to antihypertensive medications and clinical inertia, and also enable multi-professional team-based management of hypertension. However, the implementation of medical telemonitoring systems in clinical practice is not easy, and substantial barriers, including the development of user-friendly devices, integration with existing clinical systems, data security, and cost of implementation and maintenance, need to be overcome. In this review, we focus on the potential of medical telemonitoring for the management of hypertension in older people in Japan.

Reinitiation and Subsequent Discontinuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers among New and Prevalent Users Aged 65 Years or More with Peripheral Arterial Disease

Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) are recommended in the treatment of arterial hypertension in patients with peripheral arterial disease (PAD). The aims of our study were: (a) to analyse the extent of reinitiation and subsequent discontinuation in older hypertensive PAD patients non-persistent with ACEIs/ARBs; (b) to determine patient and medication factors associated with reinitiation and subsequent discontinuation; and (c) to compare these factors between prevalent and new users. The analysis of reinitiation was performed on a sample of 1642 non-persistent patients aged ≥65 years with PAD newly diagnosed in 2012. Patients reinitiating ACEIs/ARBs were used for the analysis of subsequent discontinuation identified according to the treatment gap period of at least 6 months without any prescription of ACEI/ARB. In the group of non-persistent patients, 875 (53.3%) patients reinitiated ACEIs/ARBs during a follow-up (24.8 months on average). Within this group, subsequent discontinuation was identified in 414 (47.3%) patients. Being a new user was associated with subsequent discontinuation, but not with reinitiation. Myocardial infarction during non-persistence and after reinitiation was associated with reinitiation and lower likelihood of subsequent discontinuation, respectively. Being a prevalent or a new user is associated with the use of medication also after initial discontinuation.

Effects of exergame and bicycle exercise intervention on blood pressure and executive function in older adults with hypertension: A three-group randomized controlled study

Management of hypertension and prevention of cognitive decline are challenging public health problems. However, the effects of exergame intervention on blood pressure (BP) remain to be explored, and whether exergame intervention is an effective alternative to traditional physical exercise intervention for older adults with hypertension remains to be demonstrated. This study aimed to explore the effectiveness of moderate-intensity exergame intervention and bicycle exercise training on BP and executive function in older hypertensive patients. A total of 128 participants were randomly assigned to the exergame intervention group (n = 41), bicycle exercise intervention group (n = 44), and control group (n = 43). The intervention groups exercised for 60 min, 3 times per week, for 16 weeks, while the control group maintained their normal lifestyle. The results revealed that there were no significant differences between two intervention groups and control group in systolic BP and diastolic BP changes (ps > 0.05). Both intervention groups demonstrated significant improvements in working memory when compared with control group (exergame intervention group: −461.9 ms, p = 0.025; bicycle exercise intervention group: −470.1 ms, p = 0.021). There were no significant differences in systolic BP, diastolic BP, or working memory between the two intervention groups after 16 weeks of training (ps > 0.05). No difference in inhibition or cognitive flexibility was observed between the intervention and control groups (ps > 0.05). The current results showed that moderate-intensity exergame intervention did not produce significant benefits in reducing BP, but yielded similar beneficial effects in working memory to that of bicycle exercise intervention. More studies are needed on whether exergame intervention has the potential to be a promising supplemental therapeutic tool for older adults with hypertension.

S-48-1: EXERCISE TRAINING CONSIDERING THE CHARACTERISTICS OF SARCOPENIA AND FRAILTY

As Japan's population ages, the number of people with cardiovascular disease is also aging, and the frequency of frailty is increasing. Hypertension is another frequent finding in older patients. Hypertension in older patients is associated with frailty, and hypertension can be a risk factor for frailty. Studies have shown that frailty correlates with systolic blood pressure and that frailty is strongly associated with white matter lesions on brain MRI in hypertensive older patients. Thus, flail prevention is extremely important because of the potential impact of hypertension on the development of organ damage. Hypertension is also recognized as a major risk factor for cardiovascular diseases such as heart failure, atrial fibrillation, and stroke, and the development of these diseases can cause a decline in health status and/or exacerbate the degree of frailty. As people age, more people also experience blood pressure drops on standing (orthostatic hypotension), particularly as they become frail. This increases the likelihood of falls. Hypertension in older patients is also associated with sarcopenia. We, the Juntendo University Cardiac Rehabilitation Team, provide exercise training for older patients with cardiovascular disease based on the characteristics of frailty and sarcopenia. Specifically, we conduct regular frailty assessments, and in addition to aerobic exercise, we have a program that specifically focuses on improving muscle strength, muscle power, and slowness. In addition, older cardiac patients with frailty and sarcopenia may have difficulty participating in outpatient cardiac rehabilitation program due to their own low physical fitness and low physical function, distance to the hospital, and lack of caregivers who can accompany them. To overcome the extremely low participation rate in outpatient cardiac rehabilitation program in Japan, the feasibility studies of tele-cardiac rehabilitation with real-time communication are also being conducted.

PS-BPC06-8: FACTORS ASSOCIATED WITH POTENTIAL COGNITIVE FUNCTIONAL CHANGES IN OLDER PATIENTS WITH HYPERTENSION

Objective: There are many cases of potentially impaired cognitive function in older patients with hypertension. Therefore, we investigated factors associated with one-year changes in cognitive function in older hypertensive patients during outpatient visits. Design and method: We included 223 hypertensive patients (age 76.3 ± 6.3 years, 106 males) aged 65 years or older who attended outpatient hypertension clinics at six specialized institutions nationwide and had no prior diagnosis of dementia. We obtained the mini-mental state examination (MMSE) from all participants. We defined the impaired cognitive function as an MMSE score of 27 or less. At baseline and one year later, the participants were evaluated for comprehensive geriatric assessment, including MMSE, and muscle strength, with the converted group defined as having new cognitive decline at one year and the reverted group as having cognitive improvement one year after the cognitive decline. All participants gave informed consent, and our institutional review board approved the study protocol. Results: At baseline, 81 of 223 elderly hypertensive patients had impaired cognitive function. At one-year follow-up, 40 of 142 patients in the maintained cognitive function group were classified as converted, and 33 of 81 patients in the impaired cognitive function group were classified as converted. The converted group was older than the cognitively intact group (76.8 vs. 73.9 years, p &lt; 0.05), had higher home blood pressure, and had more significant grip strength loss over the year. Multivariate analysis identified age (odds ratio 1.1, 95% CI 1.0–1.2) and change in grip strength (odds ratio 0.84, 95% CI 0.72–0.99) as factors associated with the converted group. The reverted group was younger, had a higher percentage of males, and had weaker grip strength than the group with persistent cognitive decline. In multivariate analysis, grip strength (odds ratio 0.80, 95%CI 0.68–0.94) was extracted as a factor associated with the revert group. Conclusions: Potential cognitive decline was observed in 36% of older patients with hypertension. Furthermore, we examined a high rate of cases of cognitive function change over one year. Age and grip strength decline was considered responsible for cognitive conversion and baseline grip strength for revert, respectively.

PS-BPC09-3: THE ASSOCIATION BETWEEN THE FRAILTY CLASSIFICATION AND ANTIHYPERTENSIVE TREATMENT IN OLDER PATIENTS: A CROSS-SECTIONAL STUDY.

Objective: The prevalence of frailty and hypertension are both increases with age. However, the treatment target in older hypertensive patients with frailty has not yet been clearly defined. Therefore, we conducted a registry study to clarify the current status of antihypertensive treatment for older patients at our institution. Design and method: We recruited the study participants from consecutive patients who visited the Department of Geriatrics and Hypertension, Osaka University Hospital, between April 2012 and March 2022 and underwent physical function tests and comprehensive functional assessment. We obtained the data on blood pressure and treatment regimen from the medical record. All participants gave informed consent, and our institutional review board approved the study protocol. We defined frailty according to the Japanese version of the cardiovascular health study (J-CHS) criteria. Then, we performed a cross-sectional analysis of frailty and antihypertensive treatment. Results: The participants were 1,228 (537 men, aged 75.1 + /-8.5 years), classified according to the J-CHS criteria: 234 (19.0%) robust, 778 (63.4%) pre-frail, and 216 (17.6%) frail. The percentage of antihypertensive medication use was lower in the order of frail/ pre-frail/ robust (chi-square 6.71, p = 0.035). Blood pressure levels were not associated with the frailty classification. When examined by gender, neither antihypertensive treatment nor blood pressure was associated with frailty classification in women. On the other hand, in men, the antihypertensive treatment decreased with an increasing degree of frailty, and blood pressure values and pulse pressure tended to increase. Still, the mean office blood pressure in the male frailty group was 127/69 mmHg. The association between frailty classification and antihypertensive medication remained significant after adjustment for age and gender. Conclusions: At our institution, we found that antihypertensive prescriptions have decreased with the degree of frailty in older patients, especially men. The reasons for withholding antihypertensive treatment for frail older patients and its impact on the risk of cardiovascular disease require further investigation.

SP-1: AGGRESSIVE BP MANAGEMENT IN OLDER ASIAN PEOPLE

With a rapidly aging population, adequate blood pressure (BP) control is critical for hypertension management and prevention of cardiovascular events. Impressive cardiovascular benefits have been observed with intensive BP control (SBP target, &lt;120 mmHg) in the SPRINT (Systolic Blood Pressure Intervention Trial) study, even in patients 75 years of age or older. A most recent meta-analysis including 51 randomized trials with over 350,000 participants from the BPLTTC (The Blood Pressure Lowering Treatment Trialists’ Collaboration) showed that BP lowering is effective in older people for reducing major cardiovascular events. The STEP (Strategy of Blood Pressure Intervention in the Elderly Hypertensive Patients) study-a multicenter, randomized, controlled trial conducted in China, provided important evidence that intensive BP treatment (SBP target, 110 mmHg to &lt; 130 mmHg) benefits older hypertensive patients (aged 60–80 years) and reduced the incidence of cardiovascular events than standard treatment (target 130 mmHg to &lt; 150 mmHg). Because Asian people have a higher burden of hypertension and stroke than Caucasian people, intensive BP treatment has more advantages in reducing the risk of cardiovascular events including stroke in Asian hypertensive patients than in Caucasian people. Home BP monitoring is helpful to facilitate hypertension management for older patients. It should also be noted that clinical decision-making should be on a patient basis, such as fragility, diabetes, stroke, and other comorbidities, with tailored BP targets.