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Ishikawa J, Toba A, Futami S, Saito Y, Tamura Y, Araki A, Harada K. Association of pulse pressure and mean blood pressure to frailty, sarcopenia, and cognitive dysfunction in elderly outpatients with history of hypertension. Hypertens Res 2024:10.1038/s41440-024-01684-w. [PMID: 38671218 DOI: 10.1038/s41440-024-01684-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
This study aimed to evaluate the relationship between pulse pressure (PP) and sarcopenia, frailty, and cognitive function in elderly patients with hypertension. We evaluated 435 elderly patients with a history of hypertension who visited the frail outpatient clinic between July 2015 and October 2021. Data at the 1-, 2-, and 3-year follow-ups were available for 222, 177, and 164 patients, respectively. Sarcopenia, frailty, and cognitive function, including Mini-Mental State Examination (MMSE) scores, were evaluated. The patients' mean age was 79.2 ± 6.3 years (male, 34.9%). PP and mean blood pressure (BP) were 60.1 ± 13.6 mmHg and 94.1 ± 13.0 mmHg, respectively. At baseline, lower PP was associated with probable dementia (MMSE score ≤23 points) (OR = 0.960 per 1 mmHg increase; 95% CI, 0.933-0.989; P = 0.006) in the model adjusted for conventional confounding factors and comorbidities, whereas higher PP was associated with low handgrip strength (OR = 1.018 per 1 mmHg increase; 95% CI, 1.001-1.036; P = 0.041). In multivariate-adjusted logistic regression analysis of patients with preserved handgrip strength at baseline, reductions in PP (OR = 0.844; 95% CI, 0.731-0.974; P = 0.020) and mean BP (OR = 0.861; 95% CI, 0.758-0.979; P = 0.022) were significantly associated with the incidence of low handgrip strength at 3 years. In conclusion, a higher PP induced by increased arterial stiffness was associated with lower handgrip strength, whereas a lower PP was associated with probable dementia. Reduced PP was associated with decreased handgrip strength after three years.
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Affiliation(s)
- Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Ayumi Toba
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shutaro Futami
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshihiro Saito
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Chen S, Wang J, Shui W, Xing X, Zhang Z, Hou R. Association of the TNF-α-308G>A gene polymorphism with left ventricular geometry and functional abnormalities in obstructive sleep apnea subjects. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:241-248. [PMID: 38041410 DOI: 10.1002/jcu.23624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Tumor necrosis factor-α (TNF-α) can induce left ventricular remodeling. In this study, we investigated whether the TNF-α-308G>A polymorphism is associated with left ventricular geometry (LVG) and left ventricular functional abnormalities in obstructive sleep apnea (OSA) subjects. METHODS Two hundred and seventy-eight subjects were enrolled. Echocardiography and genetic data were assessed in all patients. Geometric patterns of the left ventricle were determined from the relative wall thickness and left ventricular mass index (LVMI). Genetic analysis for the TNF-α-308G>A SNP rs1800629 was identified by Sanger sequencing. The correlations of the TNF-α-308G>A polymorphism with LVG and left ventricular function were analyzed by difference analysis and logistic regression. RESULTS The chi-square test showed that there were differences in genotype distributions among the four groups (p = 0.033), such that the frequency of GA+AA genotypes was significantly higher in the concentric hypertrophy group than in the normal geometry group (p < 0.05). Independent sample T tests showed that the GA+AA genotypes had higher IVST, LVPWT, LVMI, E/e' values, and lower e' values than those of the GG genotype (p < 0.05). Logistic regression analysis showed that the TNF-α-308G>A polymorphism was independently correlated with eccentric hypertrophy (OR = 2.456, p = 0.047) and concentric hypertrophy (OR = 2.456, p = 0.047). CONCLUSION In OSA patients, the TNF-α-308G>A polymorphism was linked to LVG and abnormal left ventricular diastolic function, suggesting that the TNF-α-308G>A polymorphism may have an important influence on LVG alterations.
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Affiliation(s)
- Shuqiong Chen
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jian Wang
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Wen Shui
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xueqing Xing
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhenxia Zhang
- Department of Respiratory, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ran Hou
- Department of Ultrasound, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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Xu Y, Bouliotis G, Beckett NS, Antikainen RL, Anderson CS, Bulpitt CJ, Peters R. Left ventricular hypertrophy and incident cognitive decline in older adults with hypertension. J Hum Hypertens 2023; 37:307-312. [PMID: 35365783 PMCID: PMC10063439 DOI: 10.1038/s41371-022-00681-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/05/2022] [Accepted: 03/16/2022] [Indexed: 11/08/2022]
Abstract
The association between raised blood pressure and increased risk of subsequent cognitive decline is well known. Left ventricular hypertrophy (LVH), as a marker of hypertensive target organ damage, may help identify those at risk of cognitive decline. We assessed whether LVH was associated with subsequent cognitive decline or dementia in hypertensive participants aged ≥80 years in the randomized, placebo-controlled Hypertension in the Very Elderly Trial. LVH was assessed using 12-lead electrocardiography (ECG) based on the Cornell Product (CP-LVH), Sokolow-Lyon (SL-LVH), and Cornell Voltage (CV-LVH) criteria. The Mini-Mental State Examination (MMSE) was used to assess cognitive function at baseline and annually. A fall in MMSE to <24 or an annual fall of >3 points were defined as cognitive decline and triggered dementia screening (Diagnostic Statistical Manual IV). Death was defined as a competing event. Fine-Gray regression models were used to examine the relationship between baseline LVH and cognitive outcomes. There were 2645 in the analytical sample, including 201 (7.6%) with CP-LVH, 225 (8.5%) SL-LVH and 251 (9.5%) CV-LVH. CP-LVH was associated with increased risk of cognitive decline, subdistribution hazard ratio (sHR)1.3 (95% confidence interval (CI) 1.01-1.67) in multivariate analyses. SL-LVH and CV-LVH were not associated with cognitive decline (sHR1.06 (95% CI 0.82-1.37) and sHR1.13 (95% CI 0.89-1.43), respectively). LVH was not associated with dementia. LVH may be related to subsequent cognitive decline, but evidence was inconsistent depending on ECG criterion and there were no associations with incident dementia. Additional work is needed to understand the relationships between blood pressure, LVH assessment and cognition.
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Affiliation(s)
- Ying Xu
- Neuroscience Research Australia, Margarete Ainsworth Building, Barker Street, Randwick, NSW, 2031, Australia.
- University of New South Wales, Sydney, NSW, 2052, Australia.
| | - George Bouliotis
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Riitta L Antikainen
- Centre for Life-Course Health Research/Geriatrics, University of Oulu, Oulu, Finland
- Medical Research Centre Oulu, Oulu University Hospital, Oulu, Finland
| | - Craig S Anderson
- University of New South Wales, Sydney, NSW, 2052, Australia
- The George Institute for Global Health, Level 5, 1 King St, Newtown, NSW, 2042, Australia
- The George Institute for Global Health at Peking University Health Science Centre, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd, Haidian District, Beijing, 100088, P.R. China
- Neurology Department, Sydney Local Area Health District, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | | | - Ruth Peters
- Neuroscience Research Australia, Margarete Ainsworth Building, Barker Street, Randwick, NSW, 2031, Australia
- University of New South Wales, Sydney, NSW, 2052, Australia
- Imperial College London, London, W2 1PG, UK
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The Effect of Renal Denervation on Cardiac Diastolic Function in Patients with Hypertension and Paroxysmal Atrial Fibrillation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2268591. [PMID: 35668773 PMCID: PMC9167068 DOI: 10.1155/2022/2268591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/01/2022] [Accepted: 05/05/2022] [Indexed: 12/05/2022]
Abstract
Objective Renal artery denervation (RDN) can treat hypertension and paroxysmal atrial fibrillation (PAF). Hypertension and PAF can affect cardiac diastolic function. The study aimed to evaluate the effect of RDN on cardiac diastolic function in patients with refractory hypertension and PAF. Methods 190 consecutive patients with hypertension and PAF were recruited. The levels of NT-proBNP and metrics of echocardiography were measured before and after RDN in patients with refractory hypertension and PAF. The 190 patients were divided into the decreasing HR and nondecreasing HR group, the decreasing MAP and nondecreasing MAP group, the HFPEF group, and the normal diastolic function group, respectively. Results Before RDN, the indices about cardiac diastolic function were out of the normal range. After RDN, the diastolic function improved in the indices of NT-proBNP, E/e′, e′. The diastolic function about the indices of NT-proBNP, E/e′, e′ was improved in the decreasing HR group, the decreasing mean arterial pressure (MAP) group, and the HFPEF group, correspondingly compared to the nondecreasing HR group, the non-decreasing MAP group, and the preoperative normal diastolic function group. In the multivariate analysis, the MAP and HR were the only two indicators significantly associated with the improvement of diastolic function. Conclusion RDN could improve the diastolic function in patients with refractory hypertension and PAF. Patients with HFPEF could receive benefits through RDN. It was speculated that RDN improved the diastolic function mainly through decreasing HR and MAP.
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Tomura M, Hamasaki Y, Komaru Y, Miyamoto Y, Matsuura R, Matsumoto A, Doi K, Kume H, Nangaku M. Prognostic significance of concentric left ventricular hypertrophy at peritoneal dialysis initiation. BMC Nephrol 2021; 22:135. [PMID: 33863299 PMCID: PMC8052641 DOI: 10.1186/s12882-021-02321-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/24/2021] [Indexed: 01/19/2023] Open
Abstract
Background Concentric left ventricular hypertrophy (cLVH) is a common left ventricular geometric pattern in patients undergoing maintenance dialysis, including peritoneal dialysis (PD). The relationship between cLVH at PD initiation and the prognosis of patients remains unclear, however. This study aimed to investigate the impact of cLVH at PD initiation on patient survival and major adverse cardiovascular events (MACE). Methods The retrospective cohort study included 131 patients who underwent echocardiography during the PD initiation period. Based on echocardiographic measurements, cLVH was defined as a condition with increased LV mass index and increased relative wall thickness. The relationship between cLVH and the prognosis was assessed. Results Concentric LVH was identified in 29 patients (22%) at PD initiation, and patient survival, MACE-free survival and PD continuation were significantly reduced in the cLVH group compared with the non-cLVH group. In the Cox regression analysis, cLVH was demonstrated as an independent risk factor of mortality (HR [95%CI]: 3.32 [1.13–9.70]) for all patients. For patients over 65 years old, cLVH was significantly associated with mortality and MACE (HR [95%CI]: 3.51 [1.06–11.58] and 2.97 [1.26–7.01], respectively). Serum albumin at PD initiation was independently correlated with cLVH. Conclusions In our study, cLVH at PD initiation was independently associated with survival in all patients and with both survival and MACE in elderly patients. Evaluation of LV geometry at PD initiation might therefore help identify high-risk patients. Further studies involving larger numbers of patients are needed to confirm the findings from this study and clarify whether treatment interventions for factors such as nutrition status could ameliorate cLVH and improve patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-021-02321-1.
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Affiliation(s)
- Misato Tomura
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| | - Yoshifumi Hamasaki
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan.
| | - Yohei Komaru
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| | - Yoshihisa Miyamoto
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| | - Ryo Matsuura
- Hemodialysis and Apheresis, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, Japan
| | | | - Kent Doi
- Acute Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Haruki Kume
- Urology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masaomi Nangaku
- Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
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Pelà G, Tagliaferri S, Perrino F, Righelli I, Montanari R, Longobucco Y, Salvi M, Calvani R, Cesari M, Cherubini A, Bernabei R, Di Bari M, Landi F, Marzetti E, Lauretani F, Maggio M. Determinants of cardiac structure in frail and sarcopenic elderly adults. Exp Gerontol 2021; 150:111351. [PMID: 33864831 DOI: 10.1016/j.exger.2021.111351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cardiac structure and function change with age. The higher prevalence of left ventricular hypertrophy (LVH) with concentric remodeling is indicative of a typical geometric pattern of aging associated with a higher cardiovascular (CV) risk and diseases. The recent associations found between low left ventricular and skeletal mass in older patients with frailty and sarcopenia have raised great interest in investigating cardiac characteristics and determinants of left ventricular mass (LVM) in this population. DESIGN Cross-sectional study. METHODS We evaluated 100 sarcopenic and physically frail outpatients, 33 men (M), 67 women (F), aged ≥70 years (mean age 79 ± 5) and enrolled in the Parma site of European multicenter SPRINTT population. RESULTS All male and female participants showed LVH, assessed as indexed LVM to body surface area (LVM/BSA) (M = 128 ± 39 g/m2; F = 104 ± 26 g/m2), and were more prone to have concentric geometry, as demonstrated by relative wall thickness value (0.41 in both sexes). After backward regression analysis, including covariates such as age, sex, office or ABPM systolic blood pressure (SBP), heart rate, BSA, use of β blockers, ACE-inhibitors, angiotensin receptor blockers, calcium channel blockers, diuretics, physical activity, hemoglobin level, and Mini Mental State examination - the most powerful determinants of LVM were clinical SBP (β = 1.51 ± 0.31, p = 0.0005), BSA (β = 165.9 ± 41.4, p = 0.0001), while less powerful determinants were 24 h, daily and nightly SBP (p = 0.02, p = 0.002, p = 0.004 respectively). CONCLUSIONS Older sarcopenic and physically frail patients showed LVH with a tendency towards concentric geometry. The main determinant of LVM was SBP, highlighting the key role that hemodynamic condition plays in determining LVH in this population.
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Affiliation(s)
- Giovanna Pelà
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy.
| | - Sara Tagliaferri
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Felice Perrino
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy
| | - Ilaria Righelli
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Rossella Montanari
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Yari Longobucco
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy
| | - Marco Salvi
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy; Geriatric Clinic Unit, University-Hospital of Parma, Parma, Italy
| | - Riccardo Calvani
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Clinical and Experimental Medicine, University of Florence, Firenze, Italy; Unit of Geriatrics - Geriatrics Intensive Care Unit, Department of Medicine and Geriatrics, University-Hospital Careggi, Firenze, Italy
| | - Francesco Landi
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Emanuele Marzetti
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore and Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Fulvio Lauretani
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy; Geriatric Clinic Unit, University-Hospital of Parma, Parma, Italy
| | - Marcello Maggio
- Department of Medicine and Surgery, University Medical School of Parma, Parma, Italy; University-Hospital of Parma, Parma, Italy; Geriatric Clinic Unit, University-Hospital of Parma, Parma, Italy
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Liang X, Zhong H, Xiao L. The effect of community hypertension management on blood pressure control and its determinants in southwest China. Int Health 2020; 12:203-212. [PMID: 32176766 PMCID: PMC7320421 DOI: 10.1093/inthealth/ihaa002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/21/2019] [Accepted: 01/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Hypertension is a leading cause of cardiovascular disease (CVD). The purpose of this study was to examine the effectiveness of community healthcare in controlling blood pressure (BP) and mitigating related risk factors after 5 y of follow-up. METHODS Hierarchical clustering sampling was employed to choose a representative sample of 10 rural and 10 urban community populations (N=4235). The 5y prospective cohort study was completed by the medical group in the community clinical centre. RESULTS The study included 4235 patients, median age 69 y (range 61-76), with hypertension in 2009; 2533 (59.81%) were female. The rate of BP control increased from 28.33% in 2009 to 64.05% in 2014. The BP control rate was higher in patients with CVD and kidney disease and lower in those with obesity than in those without. Comparing 2009 and 2014 values, the intervention resulted in median systolic BP and diastolic BP reductions of 7.0 mmHg and 6.5 mmHg, respectively. Age, medication treatment, antihypertensive agents, BP at baseline and follow-up, complications of diabetes, CVD, obesity and kidney disease, the aspartate aminotransferase:aminotransferase ratio and smoking were identified as risk factors for BP control. CONCLUSIONS Community management of hypertension by general practitioners achieved significant BP control over 5 y of intervention.
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Affiliation(s)
- Xiaohua Liang
- Clinical Epidemiology and Biostatistics Department, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital, Chongqing Medical University, 136 2nd Zhongshan Avenue, Yuzhong District, Chongqing, People’s Republic of China
- Corresponding author: Tel: +86 23 63638270; Fax: +86 23 63638270; E-mail: ,
| | - Haiying Zhong
- Clinical Epidemiology and Biostatistics Department, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital, Chongqing Medical University, 136 2nd Zhongshan Avenue, Yuzhong District, Chongqing, People’s Republic of China
| | - Lun Xiao
- Centers for Disease Control and Prevention of Jiulongpo District, Chongqing, People's Republic of China
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Toba A, Ishikawa J, Suzuki A, Tamura Y, Araki A, Harada K. Orthostatic blood pressure rise is associated with frailty in older patients. Geriatr Gerontol Int 2019; 19:525-529. [PMID: 31020795 DOI: 10.1111/ggi.13656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 02/08/2019] [Accepted: 02/18/2019] [Indexed: 01/09/2023]
Abstract
AIM Orthostatic blood pressure (BP) can fall with reduced stroke volume and arterial elasticity. However, as the reason for orthostatic BP rise is unclear, we investigated the relationship of orthostatic BP rise with frailty in older patients. METHODS In 169 consecutive outpatients who visited the frailty clinic, we evaluated orthostatic BP and heart rate changes (i.e. in the sitting position, just after standing up, 1 min after standing and after sitting down). Frailty was evaluated using the Kihon Checklist (KCL) established by the Ministry of Health, Labor and Welfare. RESULTS The mean age was 77.4 ± 6.9 years, and 29% of patients had frailty with a KCL score ≥8. The systolic BP declined in both groups, but patients with frailty experienced a smaller decrease just after standing (-0.2 ± 10.3 vs -6.2 ± 11.5, P = 0.001). During standing for 1 min, elevation of systolic BP was greater in patients with frailty than in those without (8.4 ± 11.6 mmHg vs 3.2 ± 11.2 mmHg, P = 0.009). The difference in elevation of systolic BP remained significant, even after adjusting for confounding factors including systolic BP before standing (P = 0.013). In particular, the KCL score for motor function was significantly correlated with an elevation of orthostatic systolic BP after standing for 1 min, even after controlling for systolic BP before standing and confounding factors (P = 0.020). CONCLUSIONS The elevation of systolic BP after standing for 1 min was greater in patients with frailty as diagnosed by the KCL score, especially in relation to reduced motor function. Geriatr Gerontol Int 2019; 19: 525-529.
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Affiliation(s)
- Ayumi Toba
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Ayumi Suzuki
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Yoshiaki Tamura
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Atsushi Araki
- Department of Diabetes, Metabolism and Endocrinology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
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Ishikawa J, Yamanaka Y, Watanabe S, Toba A, Harada K. Cornell product in an electrocardiogram is related to reduced LV regional wall motion. Hypertens Res 2018; 42:541-548. [PMID: 30542082 DOI: 10.1038/s41440-018-0164-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/11/2018] [Accepted: 09/20/2018] [Indexed: 11/09/2022]
Abstract
Electrocardiographic left ventricular hypertrophy (LVH) diagnosed by Cornell product and the Sokolow-Lyon voltage are associated with anatomical LVH; therefore, we investigated whether Cornell product and the Sokolow-Lyon voltage were associated with echocardiographic regional wall motion (measured by 2D-strain imaging). We reviewed data on 288 consecutive hypertensive patients who underwent both echocardiography and electrocardiography. Electrocardiographic LVH was calculated as follows: Cornell voltage, S in lead V3 + R in lead aVL; Cornell product, Cornell voltage (+0.6 mV for females) × QRS duration; and Sokolow-Lyon voltage, S in lead V1 + R in lead V5. The mean age of the subjects was 64.3 ± 13.2 years; 47.9% were men, and 65.2% were taking antihypertensive medications. Both Cornell product (r = 0.392, P < 0.001) and the Sokolow-Lyon voltage (r = 0.315, P < 0.001) were significantly related to left ventricular mass index (LVMI), and the relationship between Cornell product and LVMI (beta = 0.24, P = 0.001) was independent of the Sokolow-Lyon voltage (beta = 0.25, P < 0.001). In multivariate linear regression analysis in which the two ECG-LVH were included together, Cornell product was related to global longitudinal strain (beta = 0.24, P = 0.002), even after adjusting for the Sokolow-Lyon voltage (P = 0.835). Additionally, the Cornell voltage was related to the inner/outer ratio of circumferential strain (beta = 0.17, P = 0.033) after adjusting for the Sokolow-Lyon voltage (P = 0.318). By contrast, the Sokolow-Lyon voltage was related to the relative wall thickness and E/e' on tissue Doppler imaging, even after adjusting for Cornell product. In conclusion, Cornell product and voltage were associated with longitudinal regional wall motion and with the transmurality of regional wall motion in the short axis direction.
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Affiliation(s)
- Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
| | - Yuko Yamanaka
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Shintaro Watanabe
- Department of Cardiology, Sano Kosei General Hospital, Tochigi, Japan
| | - Ayumi Toba
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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