Ambulatory blood pressure characteristics in normotensive and treated hypertensive older people

Blood Pressure Changes After a Health Promotion Program Among Mexican Workers

Background: Cardiovascular disease is becoming increasingly prevalent in low and middle-income countries (LMIC), and high blood pressure (BP) is one of the main risk factors. The efficacy and sustainability of worksite health promotion (WHP) programs for BP reduction in LMIC have yet to be determined. Methods: This non-randomized company-based trial evaluated 6- and 12-months effects of a WHP intervention on BP among 2,002 participating workers from seven Mexican companies. Intervention and control groups were assigned at the company level. The intervention included nutrition counseling, physical exercise, and stress management components. Mixed models assessed differences in BP change between intervention and control companies in intent-to-treat (ITT), per-protocol (PerP), and as-treated (AsTr) analyses, and also within-group changes stratified by company, intervention component, and baseline cardiovascular risk factor levels. All analyses were adjusted for potential confounders. We accounted for missing data and loss to follow-up using inverse probability of censoring weighting. Results: ITT analyses revealed mean BP change differences of -1.1 mmHg at 12 months (95% CI: -2.9; 0.6) in intervention companies relative to control companies. PerP and AsTr analyses confirmed this finding. Within-group analyses showed consistent BP reductions at both 6 and 12 months. Substantial differences in BP changes ranging from diastolic -6.1 mmHg, (95% CI: -11.2; -1.2) to systolic -13.0 mmHg (95% CI: -16.0; -10.1) were found among individuals with diabetes at baseline in intervention companies relative to control companies. Conclusion: After 1 year, WHP was associated with modest but uncertain BP reductions. Substantial reductions were mainly observed among diabetic workers.

Low ambulatory blood pressure is associated with lower cognitive function in healthy elderly men

INTRODUCTION

Low blood pressure (BP) has been found to be associated with cerebrovascular damage in the elderly. Studies of the relation of ambulatory BP to cognitive function in elderly persons aged 80 years or above is lacking, however.

METHODS

Ninety-seven 81-year-old men from the population study 'Men born in 1914' underwent ambulatory BP monitoring and were given a cognitive test battery, 79 subjects completing all six tests. Low ambulatory systolic blood pressure (SBP) was defined as <130 mmHg and low ambulatory diastolic blood pressure (DBP) as <80 mmHg (corresponding in terms of office BP to approximately <140 and <90 mmHg, respectively). Odds ratios (OR) for lower cognitive function were calculated using a forward stepwise logistic regression model, controlling for confounding factors.

RESULTS

Subjects with ambulatory SBP <130 mmHg had higher OR values for daytime (OR 2.6; P=0.037), nighttime (OR 3.6; P=0.032) and 24h (OR 2.6; P=0.038) BP measurements. A lower cognitive function was associated with lower nighttime SBP and DBP levels and lower 24-h mean SBP compared to subjects with higher cognitive function. OR values connected to low nocturnal SBP, had a tendency to be particularly high among subjects on anti-hypertensive drugs (OR 9.1; P=0.067, n.s.).

CONCLUSION

Ambulatory SBP levels <130 mmHg and lower nighttime SBP and DBP were associated with lower cognitive function in healthy elderly men. Further investigation is needed to ascertain the effects of the presently recommended treatment goal of <140 mmHg for office SBP also on elderly over 80 years of age.

Ambulatory blood pressure: associations with coronary heart disease in the aged Finnish population

BACKGROUND AND AIMS

Ambulatory blood pressure (ABP) has been shown to be a better predictor of cardiovascular events than clinical blood pressure (BP) in middle-aged and older populations. This study studied the association of various components of ABP (daytime, night-time, 24-hour ABP) in the presence of coronary heart disease (CHD) in an older Finnish population.

METHODS

This cross-sectional, observational, population-based study was carried out in The Lieto Health Centre, Finland, in 1998-99. The study population consisted of 502 subjects (237 men, 265 women) aged 64-87 years. ABP measurements for 24 hours, daytime (awake) and night-time (asleep), were made. Resting electrocardiograms (ECG) were recorded. A person was considered to have CHD if at least one of the following criteria was met: (I) history of coronary by-pass surgery or coronary angioplasty, (II) diagnosis of CHD in previous medical records, (III) ischemia-related changes on ECG.

RESULTS

CHD increased by 30% with a 10 mmHg increase in night-time systolic blood pressure (SBP) (OR 1.30, 95% Cl 1.15-1.47). When ambulatory 24-hour and daytime SBP values were each entered separately into the multivariate model, 24-hour SBP, but not daytime SBP, was associated with CHD.

CONCLUSIONS

The most important information gained from 24-h BP monitoring in subjects with CHD is night-time BP. Night-time BP may provide new information about the CHD risk which is not identified in common clinical diagnoses of hypertension. ABP measurements should be made to confirm sufficient control of night-time BP, especially SBP, in older people with CHD.

Psychotropics among the home-dwelling elderly--increasing trends

OBJECTIVE

To assess the level of and changes in the use of psychotropics among the home-dwelling elderly in the 1990s.

METHODS

A descriptive analysis based on data from two cross-sectional interview and health examination surveys of elderly persons aged 64 years or over conducted in Lieto, a typical semi-rural Finnish municipality, in 1990-91 and 1998-99. National prescription data were utilized to compare the use of psychotropics in the late 1990s by all Finnish home-dwelling elderly and the elderly in Lieto. In Lieto drug information was obtained from 1131 persons in 1990-91 and from 1197 in 1998-99, and the mean age of the informants was 73 years in both surveys. The brand names of the prescription drugs (both irregular and regular medication) taken by each interviewee during seven days prior to the interview were recorded and categorized by the Anatomical Therapeutic Chemical (ATC) classification system.

RESULTS

Every fourth person was taking at least one psychotropic drug in both surveys. Most users were on regular psychotropic medication. The use of hypnotics and antidepressants increased most during the study period. Polypharmacy and the use of psychotropics were most prevalent among those aged 85 years or over, with women predominating. Concomitant use of two or more psychotropics increased statistically significantly from 7% to 10% between the surveys. The young elderly, aged 64-71 years, used cyclic antidepressants equally commonly in both surveys. None of the young elderly used new atypical antipsychotics in 1998-99.

CONCLUSIONS

Psychotropics tend to be overprescribed and overused among the elderly, a group at the highest risk of adverse drug reactions. The tendency of prescribing for the elderly is not going in a better direction. New-generation psychotropics were not used. The need for long-standing use of psychotropics should be assessed regularly.