Elderly Hypertensive Subjects Research Articles

Relationship between anxiety and spiritual well-being of the elderly with hypertension during the COVID-19 pandemic.

To study the relationship between anxiety and the spiritual wellbeing of hypertensive elderly patients during the corona virus disease-2019 pandemic. The cross-sectional, correlational, analytical study was conducted from March to May 2022 in Lamongan Regency, East Java, Indonesia, after approval from the Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia, and comprised elderly hypertensive subjects aged >45 years who had good cognitive skills. Data was collected using the Geriatric Anxiety Scale and the Spiritual Wellbeing Scale. Anxiety was the independent variable, while spiritual wellbeing was the dependent variable. Data was analysed using univariate and bivariate analyses. Of the 200 subjects, 107(53.5%) were females and 93(46.5%) were males. Overall, 97(48.5%) were aged 45-49 years, 81(40.5%) had completed primary school, 96(48%) were farmers, 121(60.5%) had moderate anxiety and 80(40%) had moderate spiritual wellbeing. There was a significant relationship between anxiety and spiritual wellbeing (p<0.05). Age, education and occupation of the subjects had significant association with both anxiety and spiritual wellbeing (p<0.05). The coronavirus disease-2019 led to decreased anxiety and increased spiritual wellbeing among the hypertensive elderly.

Prevalence and determinants of left ventricular hypertrophy among elderly hypertensive patients attending tertiary health care center in West Bengal, India

: Hypertension (HTN) is one of the most prevalent, modifiable and treatable causes of cardiovascular diseases in the elderly. Damage to cardiovascular system due to chronic hypertension causes hypertensive heart disease including left ventricular hypertrophy (LVH). It is a physiological adaptation to chronic blood pressure (BP) indicating grave prognosis and should be diagnosed early.Present study therefore aimed to assess LVH and other Cardio-vascular (CV) changes and to ascertain correlation between the electrocardiographic (ECG) and radiographic / chest x-ray (CXR) evidences and find out their determinants among elderly hypertensive patients.100 elderly hypertensive subjects were included in study. Cardio-vascular changes and LVH was assessed by using chest x-ray and ECG. Other bio-chemical investigations were done also.: 29% and 32% subjects had LVH detected by Chest x-ray and ECG respectively. Female, increasing age, family history and duration of HTN, smoking, alcohol consumption were found independent determinants of LVH. Subjects with LVH had higher mean blood pressures, mean pulse pressure and higher blood urea nitrogen than those without LVH. Micro-albuminuria was significantly more frequent in patients with LVH as detected by CXR. Fasting Blood sugar and dyslipidaemia was associated with greater odds of developing LVH.In low resource settings, where standard diagnostic tests are unavailable- chest x-ray and ECG are the useful tools for detection of cardio vascular changes / LVH among chronic hypertensive.

Study of Antihypertensive Use in Elderly Subjects with or Without Comorbid Conditions in A Tertiary Care Hospital

Hypertension is the commonest cardiovascular disorder, with the prevalence progressively increasing with age and elderly subjects are more prone for various hypertension-related complications. Presence of various co-morbid conditions influences the choice and dose of antihypertensive medications. Persistent adherence to the prescribed medications and lifestyle measures are very essential to reduce the morbidity and mortality, and to improve the QOL. The objective of the study is to determine the pattern of antihypertensive prescribing, to assess the medication compliance and Quality of life. 250 elderly hypertensive subjects of either gender were recruited in to the present study to assess the prescribing pattern of antihypertensives; details of drug therapy, therapeutic class, dose, route, frequency, duration of administration. The compliance was 8-item questionnaire as per Morisky Medication Adherence Scale and the Quality of life was assessed using MINICHAL Instrument, consisting of 17-item questionnaire. The most commonly prescribed antihypertensives were angiotensin receptor blockers (55%) and calcium channel blockers (55%) and, angiotensin receptor blocker + thiazide diuretic combination was the commonest dual antihypertensive therapy prescribed. 41.2% subjects had good level of medication compliance, 48.4% subjects had moderate level of compliance and 10.4 % subjects had poor level of compliance. The mean total scores of the HRQoL scale in the subjects with pre hypertension was 26.20±8.01, 25.66±9.38 in subjects with stage 1 HTN and 29.36±8.66 in subjects with stage 2 HTN. The most common antihypertensives were angiotensin receptor blockers and calcium channel blockers. The level of compliance was influenced by factors such as age, gender, co morbidities, severity of hypertension and number of medications. HRQoL of the study population was influenced by severity of hypertension.

Physical decline and cognitive impairment in frail hypertensive elders during COVID-19

BackgroundHypertension is common in older adults and its incidence increases with age. We investigated the correlation between physical and cognitive impairment in older adults with frailty and hypertension. MethodsWe recruited frail hypertensive older adults during the COVID-19 pandemic, between March 2021 and December 2021. Global cognitive function was assessed through the Montreal Cognitive Assessment (MoCA), physical frailty assessment was performed following the Fried criteria, and all patients underwent physical evaluation through 5-meter gait speed test. ResultsWe enrolled 203 frail hypertensive older adults and we found a significant correlation between MoCA score and gait speed test (r: 0.495; p<0.001) in our population. To evaluate the impact of comorbidities and other factors on our results, we applied a linear regression analysis with MoCA score as a dependent variable, observing a significant association with age, diabetes, chronic obstructive pulmonary disease (COPD), and gait speed test. ConclusionsOur study revealed for the first time a significant correlation between physical and cognitive impairment in frail hypertensive elderly subjects.

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions.

Evidence accumulated from the last decade has proven that silent cerebrovascular lesions (SCLs) and their underlying pathogenic processes contribute to cognitive decline in the elderly. However, the distinct effects of each type of the lesions on cognitive performance remain unclear. Moreover, research data from Chinese elderly with SCLs is scarce. In this study, 398 otherwise healthy hypertensive elderly subjects (median age 72 years) were included and assessed. All participates were required to complete a battery of structured neuropsychological assessment, including forward and backward digit span tests, symbol digit modalities test, Stroop test, verbal fluency test and Montreal Cognitive Assessment. These tests were used to assess attention, executive function, information processing speed, language, memory and visuospatial function. A multi-sequence 3T MRI scanning was arranged within one month of the neuropsychological assessment to evaluate the burden of SCLs. SCLs were rated visually. Cerebral microbleeds (CMBs) and silent lacunes (SLs) were identified as strictly lobar CMBs and SLs or deep CMBs and SLs according to their locations, respectively. Similarly, white matter hyperintensities (WMHs) were separated into periventricular WMHs (PVHs) and deep WMHs (DWMHs). A series of linear regression models were used to assess the correlation between each type of SCLs and individual cognitive function domain. The results showed that CMBs tend to impair language-related cognition. Deep SLs affect executive function, but this association disappeared after controlling for other types of SCLs. PVHs, rather than DWMHs, are associated with cognitive decline, especially in executive function and processing speed. It is concluded that different aspects of SCLs have differential impact on cognitive performance in hypertensive elderly Chinese.

PREVALENCE OF MASKED ORTHOSTATIC HYPOTENSION MEASURED BY HOME BLOOD PRESSURE MONITORING IN ELDERLY HYPERTENSIVE SUBJECTS: RESULTS OF THE HYPAUTTENS STUDY

Objective: Orthostatic hypotension (OH) is a common disease in the elderly, associated with an increased risk of falls and cardiovascular morbi-mortality. Its reproducibility in clinical setting is low. A recent, single-center study has shown the feasibility of home blood pressure monitoring (HBPM) for the detection of OH in subjects older than 65 years referred for a memory complaint, and reported a prevalence of 12% and 42% of HO in the office and ambulatory settings respectively. The prevalence of masked OH detected with HBPM in treated hypertensive elderly subjects is still not known. Design and method: 42 hypertensive patients older than 65 years without office OH were included in 8 specialized hypertension centers. Their treatment has not been changed for at least 1 month. An ambulatory OH was sought according to the following protocol: 3 measurements in sitting position at 1 minute intervals after 5 min of rest, followed by 3 measurements in standing position at 1 minute intervals, every morning and evening for 3 consecutive days, recorded by an automated device with humeral cuff. HBPM was considered valid if more than 4 out of 6 series of measurements were completed. Ambulatory OH was defined as a fall of more than 20mmHg in SBP between one of the 3 measurements in orthostatism compared to the average of the 3 measurements taken while sitting. Results: 100% of HBPM sessions were considered valid. The main characteristics of the patients were: 72 ± 6 years, 39% women, SBP/ DBP: 149 ± 20/82 ± 10 mmHg, 2.4 ± 0.9 antihypertensive drugs, 9.3% history of falls. 20 (47.6%) included patients had a masked OH according to the protocol detailed above, with an average of 2 ± 1.2 episodes and a maximum of 5 episodes. 86% of patients had at least one episode in the morning, and 57% in the evening. In multivariate analysis, no factor identified in the study was significantly associated with the existence of a masked OH. Conclusions: OH detection with HBPM in treated hypertensive elderly subjects is feasible and reveals a significant prevalence of masked OH. Prospective studies are needed to clarify the prognostic value of masked OH.

A study of risk factors and complications in elderly hypertensive subjects.

Background:Hypertension among the elderly is a major, highly prevalent yet treatable cardiovascular disease.Aims & objectives:Study aims to highlight the risk factors for hypertension in the elderly in an urban setup for the benefit of improving quality of life and also reduce the incidence of the cardiovascular related complications.Methodology:This is a Cross-sectional observational study. Included 125 study subjects based on selection criteria. The selected patients were subjected to a preformed and pretested schedule of questions pertaining to the risk factors.Results:Among the known hypertensive patients above 60 years of age, 125 subjects were included in the study. Smoking (62%), alcohol consumption (21%), family history of hypertension (26%), family history of diabetes (70%) were statistically significant risk factors observed for the development of hypertension.Conclusion:Sedentary lifestyle (physically less active) and anthropometric measures like overweight and obesity, abnormal waist circumference, and abnormal waist hip ratio were all identified as remarkable risk for hypertension. Myocardial infarction (20%), stroke (14%), and heart failure (12%) were the chart buster complications of hypertension in the vulnerable geriatric population.

Obese elderly with diabetes experience more pain and reduced quality of life compared to obese elderly with hypertension

Growth of elderly population is a worldwide phenomenon that impacts public health. The objective of this study was to compare the pain levels, strength, and quality of life among elderly obese with diabetes or hypertension. The study cohort comprised 52 obese elderly subjects with hypertension (n = 35) and diabetes (n = 17). The parameters measured were anthropometric features, handgrip strength, visual analog scale for pain, and quality of life using the World Health Organization questionnaire. The level of pain reported by obese hypertensive elderly subjects (5.3 ± 3.4) was lower than reported by obese diabetic elderly subjects (7.4 ± 2.4). Obese hypertensive elderly scored higher on quality of life (sensory functioning and past, present, and future [PPF] activities) than obese diabetic elderly. No differences were observed for the other parameters. Strength, pain, anthropometrics, and hemodynamics were not correlated to quality of life. Obese elderly diabetics exhibit worse pain scores, sensorial abilities, and PPF activities than obese hypertensive elderly individuals. The difference in pain and quality of life aspects between obese elderly individuals with hypertension and diabetes should be accounted for in health-care programs designed for these individuals.

Association of oxidative stress and endothelial dysfunction in hypertension

BackgroundBiomarkers of oxidative stress (OS) are involved in the pathophysiology of hypertension (HTN) and endothelial dysfunction is also related to HTN. Still, a significant association of OS, as well as endothelial function, remains unclear in HTN. MethodsTotalling 222 North Indian peoples aged 18–80 participated in the study. Of these participants, 74 were elderly hypertensive subjects (age ≥60 years), and 128 were normotensive subjects (age ≥60 years-control I; n = 74, and <60 years-control II; n = 74). OS was assessed by measurement of total oxidant status (TOS) and total antioxidant status (TAS) using a colorimetric and automated method developed by Erel O. Endothelial dysfunction was assessed by measurement of flow-mediated dilation (FMD) using doppler ultrasound system. ResultsTOS and OSI were significantly increased and TAS and FMD significantly decreased in patients with HTN as compared to control I and control II. The increase in the level of TOS and a decrease in the level of TAS and FMD were also evident with advancing age. FMD was negatively correlated with TOS and positively correlated with TAS. ConclusionDecreased TAS level, increased TOS level reflect OS that may be the reason for reduced FMD in elderly hypertensive patients.

Arterial hypertension and diabetes association in the elderly

High blood pressure is common in the elderly diabetic, responsible for an increase in cardiovascular risk and an acceleration of the degenerative complications of diabetes. The aim of this study was to determine the characteristics of hypertension in elderly diabetic subjects and to study its repercussions. Our descriptive study was performed in 60 hypertensive diabetic patients over than 65 years of age, followed in our department. Hypertension was defined as arterial pressure ≥ 140/90 mmHg. A complete clinical examination and a standard biological assessment were performed for each patient. The mean age of the patients was 68.72 years; 61.2% of patients were between 60 and 65 years of age. The mean duration of diabetes progression was 14.2 years and 72% of patients received insulin therapy. The majority (91%) of these patients had uncontrolled diabetes; the average HbA1c was 10.2%. The diagnosis of diabetes preceded that of hypertension in 73.6% of cases. Thirty-three percent of our population had an uncontrolled hypertension. Patients had on a salt-free diet in 18.1% of cases and a dietary salt restriction in 21.2% of cases. Among our hypertensive patients, 29.9 received a monotherapy and 44.2% a dual therapy. Dyslipidemia was found in 51.6% of our patients. A microalbuminuria was noted in 32.3% of patients. Retinopathy was found in 48% of patients, neuropathy in 34.6%. There is a history of stroke in 3.8% of cases and a history of myocardial infarction in 2.2% of cases. Coronary insufficiency was confirmed in 5.8% of cases, unexplored chest pain was found in 26.6% of cases. Intermittent claudication was noted in 24.2% of cases. This claudication was explored and confirmed in 2% of cases. Vascular metabolic complications are serious in hypertensive elderly diabetic subjects; thus, multidisciplinary care and regular monitoring is required to detect these complications early and improve life expectancy.

Comparison of efficacy of continuous and intermittent walking exercise on blood pressure and renal function in elderly hypertensive subjects: study protocol for a randomized controlled trial

Background and objectives: Hypertension (HTN) affects millions of people worldwide. HTN plays a major etiologic role in the development of cerebrovascular disease, ischemic heart disease, cardiac and renal failure. Although the treatment of HTN has been shown to prevent cardiovascular disease and to extend life, HTN remains inadequately managed everywhere. Exercise therapy has been shown to enhance efficacy of medication treatment. Even regular physical activity of lower intensity and duration has been shown to be associated with about a 20% decrease in mortality. Nevertheless, elderly individuals are limited in the duration of exercise due to their decline in physical fitness. Therefore, we aim to evaluate and compare the efficacy of continuous and intermittent exercise on blood pressure, renal function, as well as blood pressure-related variables including cardiac autonomic function, cardiovascular risks, and oxidative stress in elderly individuals with HTN. Subjects and methods: This is a prospective, randomized controlled trial. A total of 50 elderly subjects with HTN will be recruited from Mueang District, Chonburi Province, Thailand. The subjects will be randomized into two groups and undergo walking exercise training. The continuous walking exercise group (n = 25) will perform walking exercise continuously for 30 minutes/day, 3 days/week for 12 weeks. The intermittent walking exercise group (n = 25) will perform walking exercise intermittently for 10 minutes/session, 3 consecutive sessions/day with 1-minute interval between sessions, 3 days/week for 12 weeks. The primary outcome measures will be systolic and diastolic blood pressure levels and renal function (serum creatinine and uric acid concentrations, estimated glomerular filtration rate, and estimate creatinine clearance) before and 12 weeks after intervention. The secondary outcome measures will be cardiac autonomic function, cardiovascular risks (blood glucose, serum lipid profile, atherosclerogenic index), and oxidative stress (plasma malondialdehyde and blood glutathione and glutathione disulfide) before and 12 weeks after intervention. The recruitment of subjects began on May 2, 2018. Outcome measures will be analyzed on October 29, 2018. This trial will be completed on October 27, 2018. Protocol version: 1.0. This trial has been approved by the Human Ethics Committee of the Burapha University on January 15, 2018 (approval No. 218/2560). Discussion: The intermittent walking exercise can be applied as an effectively therapeutic treatment of HTN in elderly individuals. Trial registration: This trial has been registered in the Thai Clinical Trials Registry (TCTR) (identification No. TCTR20180226003) on February 23, 2018.

Relationship between saturated fatty acid intake and hypertension and oxidative stress.

This study investigated the relationship between saturated fatty acid (SFA) intake and hypertension and oxidative stress. The present cross-sectional study was conducted among the residents of Shika town, a rural area in Japan, using health examination data received between March 2014 and January 2016. Dietary intake was measured using a brief-type self-administered diet history questionnaire. Urinary 8-hydroxy-2'-deoxyguanosine levels were used to assess oxidative stress and were measured with an enzyme linked immunosorbent assay. We defined hypertension as the use of antihypertensive medication and/or blood pressure of 140/90 mmHg or higher, and elderly as subjects aged 65 years or older. Subjects comprised 585 Japanese individuals aged 40 years and older. The prevalence of hypertension was 54.2%. SFA intake was lower in hypertensive subjects and this relationship was significantly stronger for elderly subjects. A multiple logistic regression analysis after adjustments for various confounding factors revealed that SFA intake, such as total SFA, C8:0, C12:0, C14:0, C16:0, C17:0, C18:0, C20:0, and C22:0, was inversely related to hypertension in elderly subjects. It also showed that lower urinary 8-hydroxy-2'-deoxyguanosine levels correlated with a high intake of SFA, C4:0, C6:0, C8:0, C10:0, and C12:0. Our results support a relationship existing between SFA intake and hypertension and oxidative stress, and suggest that the regular consumption of SFA contributes to the prevention and treatment of hypertension in elderly patients.

A10781 Prognostic value of cardiovascular risk factors in hypertensive versus non-hypertensive middle-aged and elderly subjects

A10781 Prognostic value of cardiovascular risk factors in hypertensive versus non-hypertensive middle-aged and elderly subjects

Association between tongue pressure and subclinical carotid atherosclerosis in relation to platelet levels in hypertensive elderly men: a cross-sectional study

BackgroundAge-related low-grade inflammation causing endothelial disruption influences sarcopenia, hypertension, and atherosclerosis. We reported previously that maintenance of muscle strength in elderly hypertensive men with high platelet levels is positively associated with subclinical atherosclerosis but not in those with low platelet levels. Since reduced tongue pressure is related to sarcopenia, tongue pressure may be associated with subclinical carotid atherosclerosis in hypertensive elderly subjects, and platelet levels may function as an indicator of the association between tongue pressure and subclinical carotid atherosclerosis.MethodsWe conducted a cross-sectional study of 342 hypertensive elderly Japanese men aged 60–89 who participated in an annual health check-up in 2015 and 2016. Subclinical carotid atherosclerosis was defined as a common carotid intima-media thickness (CIMT) of 1.1 mm or more.ResultsIn the overall study population, 171 subjects demonstrated low platelets (< 21.4 × 104/μL). Tongue pressure was significantly inversely associated with subclinical carotid atherosclerosis in these subjects, but not in subjects with high platelets. The known cardiovascular risk factor adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of subclinical carotid atherosclerosis for a 1 standard deviation (SD) increment in tongue pressure (10.4 kPa) were 0.54 (0.35, 0.85) and 1.31 (0.87, 1.96), respectively.ConclusionTongue pressure is inversely associated with subclinical carotid atherosclerosis in hypertensive elderly men with low platelet levels, but not in those with high levels. This finding may thus constitute an efficient tool for clarifying the background mechanism of age-related diseases such as sarcopenia, hypertension, and atherosclerosis.

Resistance Exercise Training Is More Effective than Interval Aerobic Training in Reducing Blood Pressure During Sleep in Hypertensive Elderly Patients.

Bertani, RF, Campos, GO, Perseguin, DM, Bonardi, JMT, Ferriolli, E, Moriguti, JC, and Lima, NKC. Resistance exercise training is more effective than interval aerobic training in reducing blood pressure during sleep in hypertensive elderly patients. J Strength Cond Res 32(7): 2085-2090, 2018-An appropriate fall in blood pressure (BP) during sleep is known to be related to a lower cardiovascular risk. The objective of this study was to compare the effect of different types of training on hypertensive elderly patients under treatment in terms of pressure variability assessed by the nocturnal decline in BP. Hypertensive elderly subjects under pharmacological treatment were randomly assigned to the following groups: 12 weeks of continuous aerobic training, interval aerobic training (IA), resistance training (R), or control (C). All subjects underwent ambulatory BP monitoring before and 24 hours after the last exercise session. The results were assessed using the mixed effects model. A greater nocturnal decline in diastolic BP compared with the wakefulness period was observed in R in comparison with C (11.0 ± 4.1 vs. 6.0 ± 5.7 mm Hg and p = 0.01) and with IA (11.0 ± 4. vs. 6.5 ± 5.1 mm Hg and p = 0.02). No fall in BP during a 24-hour period was observed in training groups compared with C, perhaps because the subjects were mostly nondippers, for whom the effect of training on BP is found to be lower. In conclusion, resistance training promoted a greater nocturnal fall in BP among hypertensive elderly subjects under treatment compared with IA subjects.

Estilo de vida e adesão ao tratamento de hipertensão arterial sistêmica em homens idosos

Objective: To assess the lifestyle and adherence to treatment of systemic arterial hypertension (SAH) in elderly men. Methods: This is a cross-sectional and descriptive study with a quantitative approach, developed with 254 elderly men, meeting the following inclusion criteria: male, aged over 60 years, undergoing follow-up of SAH evolution in primary care. Data collection took place by means of two questionnaires: a semi-structured one, containing questions related to personal and family data on health and lifestyle conditions, and the Questionnaire on Adherence to the Treatment of Systemic Arterial Hypertension, between October and December 2016. Results: A majority of the elderly men were aged between 70 and 79 years (93; 36.5%), marital status married/stable union (174; 68.5%) and retired (200; 78.7%). There was a predominance of hypertensive patients who stopped taking the antihypertensive medication at least once a year, and eat practically fat-free and sugar-free foods, without consumption of sugary drinks (120; 47.2%). Lifestyle is marked by the coexistence of food groups liable to improve or disturb the adherence to the treatment of hypertension in elderly subjects. Conclusion: Partial adherence was observed in the elderly men investigated, who adopt some healthy habits as a compensatory mechanism to maintain practices that hinder the adherence to treatment.

Optimal Blood Pressure in Elderly Hypertensive Subjects: A Korean National Health Insurance Service Health Examinee Cohort Study.

To describe the association between mean blood pressure (BP) and clinical outcomes and to investigate the optimal BP in elderly hypertensive subjects. This study used the National Health Insurance Service health examinee cohort. Subjects aged >60 years with a new diagnosis of hypertension from 2003 to 2006 were selected. Patients with previous major cardiovascular events were excluded. The remaining 23,523 subjects were divided into three groups according to the average of the observed systolic BP (SBP) and diastolic BP (DBP): (i) average SBP <130 mm Hg (n = 6,893), 130-140 mm Hg (n = 8,676), and ≥140 mm Hg (n = 7,954) or (ii) average DBP <80 mm Hg (n = 9,273), 80-90 mm Hg (n = 11,607), and ≥90 mm Hg (n = 2,643). Compared with SBP ≥140 mm Hg, SBP 130-140 mm Hg was associated with significantly lower rates of all-cause mortality (hazard ratio (HR) = 0.69, 95% confidence interval (CI) = 0.62-0.76, P < 0.001) and cardiovascular mortality (HR = 0.61, 95% CI = 0.50-0.75, P < 0.001). However, SBP <130 mm Hg did not show further lowering of all-cause and cardiovascular mortality rates compared with SBP 130-140 mm Hg. DBP 80-90 mm Hg was also associated with lower risks of all-cause death (HR = 0.64, 95% CI = 0.57-0.72, P < 0.001) and cardiovascular death (HR = 0.51, 95% CI = 0.40-0.64, P < 0.001) compared with DBP ≥90 mm Hg. There were no additional benefits with DBP <80 mm Hg for all-cause death and cardiovascular death. Mean BP of <140/90 mm Hg were associated with lowest all-cause and cardiovascular mortality without any further benefit with mean BP <130/80 mm Hg.

An operational definition of SHATS (Systemic Hemodynamic Atherosclerotic Syndrome): Role of arterial stiffness and blood pressure variability in elderly hypertensive subjects

BackgroundCV risk exponentially increases as the number of damaged organs increases The Systemic Hemodynamic Atherosclerotic Syndrome (SHATS) represents a novel conceptualization of the CV continuum focusing on simultaneous multi-organ alteration.This is the first study operationally defining SHATS and aimed at identifying its determinants. MethodsLeft Ventricular Hypertrophy (echocardiography), Common Carotid Artery plaque and increased thickness (ultrasound), and Chronic Kidney Disease (estimated Glomerular Filtration Rate) indexed selective target organ damage. SHATS was operationally defined as their simultaneous presence in a patient. PWV was measured by Sphygmocor® and BP variability by 24 h ABPM. ResultsSHATS affected 19.9% of the 367 studied subjects. Subjects with SHATS had a similar prevalence in diabetes mellitus, but a greater prevalence of very stiff artery (84.9 vs 64.3%, p < 0.01) and use of antihypertensive medications. In the presence of similar office BP, SHATS was associated with higher 24 h SBP and lower 24 h DBP (a greater pulsatile pressure!), reduced nighttime SBP fall, and a twofold greater prevalence of reverse dipper status (48.2 vs 20.2%, p < 0.001).BMI (positive correlation) and DBP (negative correlation) were the only traditional CV risk factors significantly associated with the odds of having SHATS. Very stiff artery and BP variability were significant independent determinants of SHATS, with highly predictive accuracy. ConclusionSHATS, the simultaneous damage of multiple target organs, may easily operationally defined. Very stiff artery and BP variability represent key factors for SHATS. The present results support the hypothesis of SHATS as a systemic condition, needing further characterization.

Low-frequency and low-intensity ultrasound increases cardiac parasympathetic neural activity and decreases clinic hypertension in elderly hypertensive subjects with type 2 diabetes

BackgroundThe aims of the present study were to determine the effects of an ultrasound irradiation on clinic hypertension and the heart rate variability in elderly hypertensive subjects with type 2 diabetes. MethodsWe examined the effects of ultrasound (800 kHz, 25 mW/cm2) applied to the forearm for 10 min on the autonomic nerve activity and the difference between BP at home and at a clinic visit in Japanese subjects with type 2 diabetes and hypertension. ResultsIn 108 subjects who displayed systolic BP (SBP) >140 mm Hg at a clinic visit, 75 subjects (69%) had a mean SBP <135 mm Hg at home and 33 subjects (31%) had a mean SBP >135 mm Hg at home in the morning for 14 days. SBP, pulse rate, and pulse pressure in the ultrasound treatment group were significantly lower than the baseline values in these hypertensive subjects with type 2 diabetes, and lower than those of placebo controls independently of SBP at home. In 31 subjects who displayed systolic BP >140 mm Hg at a clinic, standard deviation of all RR intervals and the root mean square of successive differences were significantly higher in the ultrasound treatment group than the baseline values in these hypertensive subjects with type 2 diabetes, and lower than those of placebo controls. ConclusionsThe ultrasound treatment increases the cardiac parasympathetic neural activity and decreases the differences between SBP at home and at a clinic visit in elderly hypertensive subjects with type 2 diabetes.

Combined effect of renal function and serum potassium level in sudden cardiac death in aging hypertensive subjects.

In patients with chronic kidney disease, serum potassium level is a factor influencing sudden cardiac death (SCD). The aim of our analysis was to study the combined effect of serum potassium level and renal function on the onset of SCD in elderly hypertensive subjects. Data from the 3620 hypertensive patients aged over 70 years were extracted from three randomized clinical trials included in the INDANA database. During a mean follow up of 4.5 years, 81 patients (2.24%) died from SCD. Mean serum potassium levels and prevalence of chronic kidney disease were not different in patients who died from SCD. In addition to serum potassium and creatinine levels, 14 clinical and biological variables linked to cardiovascular diseases recorded at baseline were analyzed using a Bayesian network. The area under the receiver operating characteristic curve of the Bayesian model reached 0.91. Bayesian inference was used to simulate the combined effects of serum potassium and creatinine levels on SCD. Our analysis, using simulated data from Bayesian model, showed that the estimated probabilities of SCD was significantly increased in case of hyperkalemia (>5.0 mmol/l) and in case of hypokalemia (<3.5 mmol/l) and in case of chronic kidney disease. Combined effects of serum potassium level and renal function revealed that chronic kidney disease increased the probability of SCD whatever the serum potassium level. Our results using a Bayesian model confirm the deleterious effects of hypokalemia, hyperkalemia and chronic kidney disease on SCD in elderly hypertensive patients.