Hypertension In Older Adults Research Articles

Association of tricarboxylic acid cycle related-metabolites with hypertension in older adults: a community-based cross-sectional study.

Hypertension is still a common chronic disease worldwide and seriously affects human health. Aim of this study was to investigate the association between tricarboxylic acid (TCA) cycle-related metabolites and hypertension in older adults. A total of 1127 community-dwelling older adults were included in this cross-sectional analysis, of whom 609 were assigned to the hypertension group and 518 to the no-hypertension group. Plasma concentrations of 8 TCA cycle-related metabolites (citrate, cis-aconitate, isocitrate, 2-oxoglutarate, succinate, maleate, fumarate, and malate) were determined by gas chromatography-triple quadrupole mass spectrometry. Multivariate logistic regression was used to assess the association between these metabolites and hypertension risk. After adjustment for covariates, we found that the increased plasma concentrations of 2-oxoglutarate and malate were significantly associated with hypertension. These two associations remained unchanged after using the false discovery rate (FDR)-adjustment method (both FDR-adjusted P-trend <0.05). In stratified analysis, these two associations were not modified by overweight, physical activity, and current drinking (all P-interaction >0.05). In the multivariate diagnostic model, the inclusion of these two metabolites modestly and significantly improved the diagnosis of hypertension (AUC = 0.64, 95% CI: 0.60-0.67). These results indicated that plasma 2-oxoglutarate and malate might be the candidate metabolic markers of hypertension among older adults. However, further longitudinal and experimental studies are necessary to confirm this finding.

Predictive modeling of preoperative acute heart failure in older adults with hypertension: a dual perspective of SHAP values and interaction analysis

BackgroundIn older adults with hypertension, hip fractures accompanied by preoperative acute heart failure significantly elevate surgical risks and adverse outcomes, necessitating timely identification and management to improve patient outcomes.Research objectiveThis study aims to enhance the early recognition of acute heart failure in older hypertensive adults prior to hip fracture surgery by developing a predictive model using logistic regression (LR) and machine learning methods, optimizing preoperative assessment and management.MethodsEmploying a retrospective study design, we analyzed hypertensive older adults who underwent hip fracture surgery at Hebei Medical University Third Hospital from January 2018 to December 2022. Predictive models were constructed using LASSO regression and multivariable logistic regression, evaluated via nomogram charts. Five additional machine learning methods were utilized, with variable importance assessed using SHAP values and the impact of key variables evaluated through multivariate correlation analysis and interaction effects.ResultsThe study included 1,370 patients. LASSO regression selected 18 key variables, including sex, age, coronary heart disease, pulmonary infection, ventricular arrhythmias, acute myocardial infarction, and anemia. The logistic regression model demonstrated robust performance with an AUC of 0.753. Although other models outperformed it in sensitivity and F1 score, logistic regression’s discriminative ability was significant for clinical decision-making. The Gradient Boosting Machine model, notable for a sensitivity of 95.2%, indicated substantial capability in identifying patients at risk, crucial for reducing missed diagnoses.ConclusionWe developed and compared efficacy of predictive models using logistic regression and machine learning, interpreting them with SHAP values and analyzing key variable interactions. This offers a scientific basis for assessing preoperative heart failure risk in older adults with hypertension and hip fractures, providing significant guidance for individualized treatment strategies and underscoring the value of applying machine learning in clinical settings.

Blood pressure and hypertension in older adults with a history of regular cannabis use: findings from the Multi-Ethnic Study of Atherosclerosis.

Observational evidence investigating associations between cannabis use and blood pressure and hypertension is inconsistent. Cross-sectional data from 3,255 participants at Exam 6 (2016-2018) of the Multi-Ethnic Study of Atherosclerosis (MESA) were analyzed, including self-reported cannabis smoking patterns, standardized measures of systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP; BP collectively), and hypertension. ANCOVA and multivariable relative risk regression models were used to calculate adjusted means for BP and adjusted prevalence ratios (PRs) for prevalent hypertension. In fully adjusted ANCOVA models, a history of regular cannabis smoking, when compared to no history, was not significantly associated with increased SBP [mean difference: 0.1 mmHg (95% CI: -1.6-1.9)], DBP [mean difference: 0.5 mmHg (95% CI: -0.3-1.4)], PP [mean difference: -0.5 mmHg (95% CI: -1.8-0.9)], or prevalent hypertension [PR: 1.01 (95% CI: 0.93-1.10)]. Furthermore, no associations were observed for either the duration or recency (in the past month) of cannabis smoking or number of joint/pipe years. Models exploring potential interactions between a history of regular cannabis smoking and age, sex, race/ethnicity, and cigarette smoking status were not significant for either BP or hypertension. In a cohort of racially and ethnically diverse older adults with a high prevalence of hypertension, no evidence of increased risk due to regular cannabis smoking was found for either blood pressure or hypertension.

What is the role of leisure-time physical activity in the association between neighborhood environmental characteristics and hypertension in older adults? The EpiFloripa Aging Cohort study

BackgroundResearch suggests a link between the urban built environment and blood pressure, potentially mediated by physical activity. This study aims to investigate the relationship between perceived neighborhood characteristics and blood pressure in older adults, as well as the mediating role of walking in this relationship. MethodsData from the third wave of the EpiFloripa Aging Cohort Study in Florianopolis, Brazil (2017–2019; n = 1335) were used for this cross-sectional analysis. Blood pressure was measured using digital devices, and hypertension diagnosis relied on healthcare professionals’ information. The neighborhood environment was assessed with the Abbreviated Neighborhood Environment Walkability Scale, while walking was evaluated with the International Physical Activity Questionnaire. Multilevel logistic regression analyzed the association between the neighborhood environment, blood pressure, and hypertension. Structural equation modeling assessed the mediation effect of walking. ResultsHypertension prevalence was 85.3 %, with 69.0 % having objectively measured elevated blood pressure. Results showed that older adults perceiving better infrastructure for physical activity (OR: 0.88; CI: 0.78–0.99), increased safety in their neighborhood (OR: 0.88; CI: 0.79–0.99), traffic security (OR: 0.88; CI: 0.78–0.99) and better overall perception of the environment (OR: 0.73; IC: 0.55–0.98) had a lower likelihood of self-reported hypertension. The association between self-reported hypertension and overall perception of the environment was partially explained by leisure-time walking (β = -0.01; p < 0.05). ConclusionOur findings suggest that public policies promoting the establishment of safe and supportive spaces for physical activity emerge as essential measures in the prevention and management of hypertension in older adults.

HYPERTENSION IN THE ELDERLY: CHALLENGES IN MANAGEMENT AND TREATMENT

Hypertension is a prevalent and significant health issue among the elderly, contributing to increased risks of cardiovascular diseases, stroke, and kidney failure. Managing hypertension in older adults poses unique challenges due to age-related physiological changes, comorbidities, and polypharmacy. This review explores the complex pathophysiology of hypertension in the elderly, including age-related changes in vascular function and the impact of comorbid conditions. It examines the difficulties in diagnosing hypertension, such as variability in blood pressure readings, white coat syndrome, and masked hypertension, highlighting the need for accurate monitoring through home and ambulatory techniques. The review discusses current management strategies, emphasizing the importance of setting appropriate treatment goals, implementing lifestyle modifications, and utilizing pharmacological treatments, including new antihypertensive drugs and combination therapies. It also addresses challenges such as adverse drug reactions, medication adherence, and the management of polypharmacy. Recent advances, including innovations in drug delivery systems and digital health technologies, offer promising solutions for improving hypertension management. Future research directions include exploring precision medicine, understanding the role of the gut microbiome, and addressing health disparities. Clinicians are advised to adopt personalized treatment approaches, integrate technological tools, and address socioeconomic barriers to optimize hypertension management in the elderly. This review underscores the need for ongoing research and tailored strategies to improve outcomes and quality of life for older patients with hypertension.

Exposure to Multiple Metal(loid)s and Hypertension in Chinese Older Adults.

Evidence about effects of metal(loid)s on hypertension among adults is insufficient. The aim of our study was to evaluate the individual and joint associations between seven selected metal(loid)s and hypertension, including lead (Pb), manganese (Mn), nickel (Ni), arsenic (As), cadmium (Cd), chromium (Cr), and vanadium (V)) in Chinese older adults. This study included 1009 older adults, and the blood concentrations of seven metal(loid)s were evaluated by inductively coupled plasma mass spectrometry (ICP-MS). The following conditions were considered as hypertension: (1) either systolic blood pressure ≥ 140mm Hg or diastolic blood pressure ≥ 90mm Hg, (2) a self-reported history of hypertension, or (3) currently taking antihypertensive medications. Logistic regression was utilized to investigate the association between individual metal(loid) and hypertension, while Bayesian kernel machine regression (BKMR) was employed to investigate the association of the metal(loid) mixture with hypertension. Adjusted single-metal(loid) model showed a significant positive association between Pb and hypertension (OR = 1.24, 95%CI = 1.03-1.50). This significant association still existed in multi-metal(loid) model (OR = 1.22, 95%CI = 1.01-1.47). BKMR further indicated a positive linear association of Pb with hypertension. The metal(loid) mixture was positively associated with hypertension in older adults, although not significant. Within the mixture, Pb had the highest posterior inclusion probabilities value (PIP = 0.9192). There were multiplicative interactions of Pb and Mn on hypertension. In addition, Pb and Mn had additive effects on the association of other blood metal(loid)s with hypertension. The associations of multiple metal(loid)s with hypertension are dependent on diabetes, areas, age, and BMI. The metal(loid) mixture exposure may contribute to hypertension in Chinese older adults, mainly driven by Pb and interactions of Pb and Mn. Reducing exposure to these metal(loid)s may prevent hypertension among older adults, which is especially true for those living with diabetes.

Twelve hot questions in the management of hypertension in patients aged 80+ years and their answers with the help of the 2023 European Society of Hypertension Guidelines.

Arterial hypertension is a major risk factor for cardiovascular morbidity and mortality, and highly prevalent in older age, underscoring the importance of its appropriate management. The population is ageing at an increasing rate, with those aged 80+ years being the fastest growing population characterized by high heterogeneity in terms of functionality and autonomy. The prevalence of hypertension rises with increasing age, due to a significant increase in SBP largely as a result of age-related stiffening of the aorta and other large arteries, affecting almost 80% of those aged 80+ years. Appropriate management of blood pressure in this population is a priority for clinicians. Frailty is a condition characterized by marked vulnerability to adverse health outcomes and is common among older adults including those with hypertension. Hypertension increases frailty level and at the same time, individuals with increasing frailty present with more drug-related adverse effects meaning they are less tolerant to blood pressure lowering by medication. Thus, frailty is a factor that should be integrated when treating hypertension in this population. The European Society of Hypertension 2023 Guidelines on the management of Hypertension are the first international guidelines to integrate the concept of adapting blood pressure management in older adults according to their frailty/functionality level, and to propose practical tools for the application of this concept in the daily practice of physicians and other healthcare professionals. The present article prepared by the European Society of Hypertension Working Group on Hypertension in Older Adults aims to further address some important aspects mentioned concisely in the 2023 European Society of Hypertension guidelines, in order to help physicians and other healthcare professionals including those practicing in primary care. To this end, this study discusses 12 'hot questions' which are answered with the help of the 2023 European Society of Hypertension Guidelines. We hope the present article and Working Group's actions will contribute to understanding and applying the ideal management of hypertension in this most vulnerable population.

Abstract P349: Prediabetes Increases the Risk of Frailty in Pre-frail Hypertensive Older Adults: Beneficial Effects of Metformin Treatment

Background: Prediabetes has garnered increasing attention due to its association with cardiovascular conditions, especially hypertension, which increases the risk of prefrailty and frailty among older individuals. Methods: We screened older adults with prefrailty and hypertension from March 2021 to January 2023. We assessed the correlation linking cognitive dysfunction (Montreal Cognitive Assessment score), insulin resistance (triglyceride-to-glucose index), and physical impairment (5-meter gait speed). Then, we measured the risk of developing frailty after a 1-year follow-up period, adjusting the outcome using multivariable Cox regression analysis. We also investigated the impact of administering 500 mg of metformin once daily to a subset of frail subjects for an additional 6 months. Results: We assessed the relationship between the triglyceride-to-glucose index and the Montreal Cognitive Assessment score, observing a significant correlation (r: 0.880; P&lt;0.0001). Similarly, we analyzed the association between the triglyceride-to-glucose index and 5-meter gait speed, uncovering a significant link between insulin resistance and physical impairment (r: 0.809; P&lt;0.0001). Prediabetes was found to significantly (P&lt;0.0001) elevate the risk of frailty development compared with individuals without prediabetes by the end of the 1-year follow-up, a finding confirmed via multivariable analysis with Cox regression. Furthermore, among the subgroup of subjects who developed frailty, those who received metformin exhibited a significant decrease in frailty levels (P&lt;0.0001). Conclusions: Insulin resistance and prediabetes play substantial roles in the development of cognitive and physical impairments, highlighting their importance in managing hypertension, even before the onset of frank diabetes. Metformin, a well-established drug for the treatment of diabetes, has shown favorable effects in mitigating frailty.

Antihypertensive medications and dementia in older adults with hypertension.

Studies on middle-aged or individuals with cognitive or cardiovascular impairments, have established that intensive blood pressure (BP) control reduces cognitive decline risk. However, uncertainty exists on differential effects between antihypertensive medications (AHM) classes on this risk, independent of BP-lowering efficacy, particularly in community-dwelling hypertensive older adults. A post-hoc analysis of the ASPREE study, a randomized trial of low-dose aspirin in adults aged 70+ years (65+ if US minorities) without baseline dementia, and followed for two years post-trial. Cox proportional-hazards regression models were used to estimate associations between baseline and time-varying AHM exposure and incident dementia (an adjudicated primary trial endpoint), in participants with baseline hypertension. Subgroup analyses included prespecified factors, APO ε4 carrier status and monotherapy AHM use. Most hypertensive participants (9,843/13,916; 70.7%) used AHMs. Overall, 'any' AHM use was not associated with lower incident dementia risk, compared with untreated participants (HR 0.84, 95%CI 0.70-1.02, p=0.08), but risk was decreased when angiotensin receptor blockers (ARBs) were included (HR 0.73, 95%CI 0.59-0.92, p=0.007). ARBs and β-blockers decreased dementia risk, whereas angiotensin-converting enzyme inhibitors (ACEIs) and diuretics increased risk. There was no association with RAS modulating or blood-brain-barrier crossing AHMs on dementia risk. Overall, AHM exposure in hypertensive older adults was not associated with decreased dementia risk, however, specific AHM classes were with risk direction determined by class; ARBs and β-blockers were superior to ACEIs and other classes in decreasing risk. Our findings emphasize the importance of considering effects beyond BP-lowering efficacy when choosing AHM in older adults.

Community Nursing Care: Unhealthy Lifestyle as A Risk Factor of Hypertension in Older Adults in Rural Areas

Introduction: Adults-elderly habits of unhealthy lifestyles increase the risk of hypertension. The high incidence of hypertension causes indications for the diagnosis of community health deficit. Hypertension can be associated with heredity, an unhealthy lifestyle such as smoking, less consumption of vegetables and fruits, lack of physical activity, alcohol consumption and stress. Objective: to determinan the picture of community nursing care, unhealthy lifestyles health deficit problems in older adults with behavioral promotion interventions for health efforts in RW 02 Baratan Village. Method: The method use in this study was quantitative descriptive and quota sampling technique to determine the sample. Results: The research results show that implementig promotion interventions for health efforts are able to increase knowledge, atttudes, and behavior towards healthy lifestyles through education programs, exercise, and demonstrations. The Sig(2-tailed) value obtained in the knowledge category was P=0.025; attitude category P=0.000; behavior category P=0.000 where a&lt;0.05 means there is a difference between before and after implementation. Conclusion: There has been increase in health program participation, health standars compliance, and monitoring of communty health standards.

The association between health literacy and self-care of hypertension among older adults in five regions in Jordan

Purpose This study aims to determine the relationship between health literacy and the self-care of hypertension in older adults in five regions in Jordan. Design/methodology/approach A cross-sectional study was conducted with 1,100 older adult patients with hypertension who had follow-ups in cardiac clinics of the five biggest hospitals in five regions of Jordan. The research instruments included a Health Literacy Questionnaire (CHEWQ) and the self-care of hypertension inventory. Findings The average health literacy score was 8.52 ± 1.6, indicating inadequate health literacy, while their self-care of hypertension score was 42.33 ± 10.9, indicating low self-care. Inadequate health literacy and factors such as marital status, education level, income and overall health status were linked to poor self-care of hypertension (p &lt; 0.05). Practical implications This study suggests that there is a need to assess the effectiveness of various health literacy interventions, such as educational programs and customized communication strategies, in enhancing self-care behaviors across diverse populations, particularly among the elderly. Originality/value The study findings highlight the need for nursing interventions aimed at improving health literacy to enhance the ability of older adults in Jordan to manage their hypertension.

The Effects of Functional Training on the Ambulatory Blood Pressure and Physical Fitness of Resistant Hypertensive Elderly People: A Randomized Clinical Rehearsal with Preliminary Results.

This study evaluated the impact of functional training (FT) on the ambulatory blood pressure and physical fitness of resistant hypertensive older adults. This randomized clinical and controlled rehearsal involved 15 participants from Juazeiro do Norte-CE divided into two groups: a control group (CG), n = 7, without physical training, and an experimental group (EG), n = 8, subjected to 24 sessions of FT. The comparative analysis included ambulatory blood pressure (24 h mapping) and physical fitness (Senior Fitness Test), using an ANOVA of two factors, an alpha of 0.05, and a post hoc by Bonferroni where necessary. The dimension of the intervention effect was verified using Eta Squared. The results show that FT promoted a significant reduction in systolic blood pressure (SAP) during the day and at night, as well as improving physical fitness, including the force/resistance of the lower and upper limbs, physical mobility, and aerobic resistance. The flexibility of the upper and lower limbs was not affected. It is concluded that FT is effective in reducing SAP and improving physical fitness in resistant older adults. However, this type of training may positively influence general physical fitness of older adults with resistant hypertension.

Benson Relaxation Therapy: Impact on Blood Pressure in Hypertensive Older Adults – A Literature Review

Introduction: The high incidence of hypertension can have an impact on increasing death rates in the world because it can cause heart failure and coronary heart disease and increase the risk of stroke. A strong emphasis on managing essential HTN with non-pharmacological interventions involving multiple elements of lifestyle modification, focusing on more permanent measures to help improve the overall quality of life and decrease physician dependence and hospitalizations of severe complications. This study aimed to explore the effect of Benson relaxation therapy on blood pressure in older adults with hypertension. Method: The method used in this literature review was to examine the results of previous research in published articles. Article searches were carried out via PubMed, Science Direct, and Google Scholar using the keywords "Benson Relaxation," "Blood Pressure," AND "Hypertensive Older adults," as well as combinations of these keywords such as "Benson relaxation on older adults hypertensive blood pressure." Fifteen articles were extracted based on the inclusion that Benson relaxation and other relaxation treatments significantly reduced blood pressure values in hypertension sufferers.Results: There were 15 articles focused on Benson therapy. Eleven studies were of pre-experimental study design. The remaining studies were case study groups (two) and one randomized control study. All of the articles combine deep breathing relaxation and religious relaxation. Conclusion: Benson relaxation has a significant effect on reducing blood pressure values in hypertension sufferers.

Physically Active Lifestyle Attenuates Impairments on Lung Function and Mechanics in Hypertensive Older Adults.

Physical activity attenuates hypertension in older adults, but its impact on pulmonary function and mechanics in hypertensive older adults is unknown. The study seeks to understand whether a physically active lifestyle can improve respiratory capacity, the mechanical efficiency of the lungs, and, consequently, the quality of life of these individuals, comparing data between groups of active and sedentary hypertensive older adults. This is a cross-sectional study. We evaluated 731 older adults, stratified into two initial groups: hypertensive older adults (HE; n = 445) and non-hypertensive older adults (NHE; n = 286). For a secondary analysis, we used the International Physical Activity Questionnaire to sub-stratify HE and NHE into four groups: physically inactive hypertensive (PIH; n = 182), active hypertensive (AH; n = 110), physically inactive non-hypertensive (PINH; n = 104), and active non-hypertensive (ANH; n = 65). Lung function was measured by spirometry, and lung mechanics were assessed by impulse oscillometry. Hypertensive older adults presented reduced lung function compared to non-hypertensive older adults, and physical inactivity accentuated this decline. Regarding pulmonary mechanics, hypertensive older adults had higher resistance of the entire respiratory system (R5 Hz), the central airways (R20 Hz), and peripheral airways (R5-20 Hz), which may trigger bronchoconstriction. Hypertension is associated with impaired lung function and mechanics in older adults, and a physically active lifestyle attenuates these dysfunctions.

Depression, Perfectionism, and Hypertension in the Elderly: A Path Analysis Examining Worry, Ambiguity Tolerance, and Problem-Solving

Introduction: Hypertension is a prevalent condition among the elderly, significantly contributing to the burden of cardiovascular disease and related complications. This study examined how depression and perfectionism influence hypertension in older adults. It also explored how worry, tolerance for ambiguity, and problem-solving skills might influence this relationship. Methods: Researchers recruited 192 participants with hypertension from a health center in Khoy city, Urmia, Iran. Participants completed questionnaires that assessed depression, perfectionism, worry, ambiguity tolerance, and problem-solving skills. Statistical methods were used to analyze the data and identify relationships between these factors and hypertension. Results: Depression, perfectionism, worry, and ambiguity tolerance were all significantly associated with hypertension. Interestingly, problem-solving skills were not linked to blood pressure. Further analysis revealed that worry played a reinforcing role in the link between depression/perfectionism and hypertension, while ambiguity tolerance had a protective effect. In other words, higher worry levels strengthened the association between depression/perfectionism and high blood pressure, while greater tolerance for ambiguity lessened this association. Conclusion: These findings suggest that emotional factors like worry and intolerance for ambiguity can significantly impact blood pressure in older adults. Therefore, managing these emotions alongside depression and perfectionistic tendencies may be crucial for controlling hypertension.

Predictors of 5-year Survival of Elderly with Hypertension. A Prospective Cohort Study.

Given the high prevalence of hypertension in older adults, this study was conducted to identify the factors affecting the 5-year survival of older people with hypertension. In this cohort study, individuals aged 60 and over living in Amirkola, north of Iran who were diagnosed with hypertension were followed up for 5 years, and the effect of various factors on their survival was analyzed. Among 1439 older people, 892 individuals (61.99%) had hypertension. Age (adjusted hazard ratio [aHR] =1.052, 95% confidence interval [CI] =1.019-1.086, P = 0.002), diabetes mellitus (aHR = 2.166, 95% CI = 1.398-3.354, P = 0.001), serum creatinine (aHR = 2.163, 95% CI = 1.391-3.363, P = 0.001), female gender (aHR = 0.460, 95% CI = 0.276-0.766, P = 0.003), body mass index ≥30 kg/m2 (aHR = 0.386, 95% CI = 0.212-0.701, P = 0.002), physical activity score >150 (aHR = 0.382, 95% CI = 0.162-0.898, P = 0.027), each one unit increase of social support score (aHR = 0.914, 95% CI = 0.861-0.970, P = 0.003), and instrumental functional ability score (aHR = 0.907, 95% CI = 0.843-0.974, P = 0.009) showed a significant effect on 5-year survival of older people. Multiple factors (such as age, gender, social support, lifestyle behaviors, and comorbidities including diabetes mellitus and renal function) might predict the 5-year survival of the elderly with hypertension. They should be considered in health-care package of these patients.

Understanding perspective on community health literacy for promoting the health of older adults with hypertension: a qualitative descriptive study

Introduction: This study aimed to understand the community people’s experience of access, understanding, evaluation, and application of health information for self-care of hypertensive older adults, and explore the community's perspective on promoting community health literacy (CHL) on caring for hypertensive older adults. Methods: This was a qualitative descriptive study. Data were collected through focus groups and in-depth interviews in one sub-district municipality in Mahasarakham, Thailand. A total of 37 participants from older adults with hypertension, families of older adults with hypertension, and community committees were recruited based on inclusion criteria using purposive sampling. Data were then analyzed using a five-step thematic analysis. Results: Four main themes of community people’s experience emerged 1) access to health information limited by the healthcare personnel at the primary care unit (PCU), 2) understanding the health information because it is clear and familiar, and can ask the medical personnel directly, 3) do not evaluate the health information received from healthcare personnel because they trust them, and 4) applied health information to practice only taking medicine and doctor’s appointments. Three main themes to promote CHL are 1) usual healthcare activities, 2) community action, and 3) nurses at PCU, village health volunteers, and community committees should be involved in playing a key role in promoting CHL. Conclusions: Cooperation with community leaders is important to promote CHL by using active learning education and creating a supportive environment focusing on encouraging older adults to perform self-care to control their health conditions.

Workin' on our night moves: leveraging the timing of aerobic exercise to enhance cardiovascular autonomic control in hypertensive older adults.

Workin' on our night moves: leveraging the timing of aerobic exercise to enhance cardiovascular autonomic control in hypertensive older adults.

Perceived quality of care in patients with high blood pressure in primary health care

Background: the study analyzed the quality of care perceived by patients with high blood pressure in a health center in Ecuador, considering dimensions such as accessibility, opportunity, continuity, comprehensiveness, and cultural competence of the services. Hypertension in older adults represents a public health problem in the region. Objective: To analyze the quality of care perceived in patients with Arterial Hypertension in Primary Health Care. Methods: quantitative, transversal, and descriptive design. The sample was 40 patients over 65 years of age with HTN. A validated 10-item questionnaire was applied to perceived quality in several dimensions: accessibility, opportunity, continuity, comprehensiveness, and cultural competence. Results: limitations were evident in the capacity to respond to urgent needs, lack of continuity in care by the same professional, deficiencies in mental health counseling, and moderate dissatisfaction with services. Conclusions: there are significant gaps in the quality of primary care for hypertensive patients regarding accessibility, opportunity, comprehensiveness, and cultural competence. Improvements are required in these areas to ensure more responsive and patient-centered care.

BLOOD PRESSURE EFFECTS OF TRAZODONE IN HYPERTENSIVE OLDER ADULTS

Objective: Trazodone is commonly prescribed in older adults and may have hypotensive effects due to the inhibition of alpha-adrenergic receptors. The present study aimed to investigate the effects of trazodone on blood pressure (BP) and its related risk of syncope and falls in hypertensive older adults. Design and method: A longitudinal observational study involving patients aged 75 or older was conducted at the Hypertension Clinic and Memory Clinic of the Division of Geriatric and Intensive Care Medicine, Careggi Hospital, Florence. Participants underwent multidimensional geriatric assessment including office BP measurement, 3-minute active stand test (BP measurement immediately after standing [T0] and at 1 [T1] and 3 minutes [T3]), home and ambulatory BP monitoring. The composite outcome of syncope and falls was assessed at 12 months and its association with trazodone was analysed using multivariate Cox regression analysis. Results: Among 123 participants (mean age 81 years, 59% female), 12 (10%) reported regular trazodone use. Participants receiving trazodone showed lower office diastolic BP (71.8 mmHg vs. 80.1 mmHg, p=0.042) and a greater systolic and diastolic BP reduction immediately after standing (δsystolicT0 16.2 mmHg vs. 9.7 mmHg, p=0.038; δdiastolicT0 11 mmHg vs. 1.7 mmHg, p=0.003). No differences were reported as regards home and ambulatory BP. Incidence of syncope and falls at 12 months was 25%, with a significantly higher rate in patients receiving trazodone (58.3% vs. 21.2%, p=0.005). Trazodone was associated with an increased risk of syncope or falls independently of physical performance (HR 2.654, 95% CI 1.104 - 6.378). This association was not confirmed when multivariate Cox analysis was adjusted for dementia diagnosis (HR for trazodone 1.874, 95% CI 0.736 – 4.773; HR for dementia 2.556, 95% CI 1.018 – 6.419). Conclusions: In older adults with hypertension, trazodone is associated with a greater orthostatic BP drop and might increase the risk of syncope and falls.