Prevalence, awareness, and control of hypertension in elderly and very elderly in Poland: results of a cross-sectional representative survey

The natural history of hypertension in older adults: a study of two Finnish generational cohorts born 20 years apart

BACKGROUND

We conducted a comparative analysis of hypertension prevalence, progression, and treatment in two Finnish population-based cohorts comprising older adults born 20 years apart. The study covered data from pre- and post-HYVET Study eras and spanned the onset of the COVID-19 pandemic.

METHODS

All 70-year-old home-dwelling citizens of Turku, in Southwest Finland, were invited to participate in the survey in 1990 (1920-born TUVA cohort) and in 2010 (1940-born UTUVA cohort) with a 25-year follow-up plan. The analyses included those with available data for systolic and diastolic blood pressure (BP), yielding 1015 TUVA and 888 UTUVA participants at baseline. Biomarkers associated with BP were analysed with t- and chi-square tests.

RESULTS

At baseline, 83.4% of TUVA and 74.3% of UTUVA participants had uncontrolled BP, with respective antihypertensive medication usage at 36.0% and 55.9% (p < .001 for both between-cohort differences). Systolic BP exhibited an inverted U-shaped trajectory, with TUVA initially 7.8 mmHg higher at 155.4 mmHg than UTUVA (p < .001). However, by the ages 80-82, the difference in systolic BP trajectories between the cohorts was attenuated to 4.0 mmHg (p = .03). Diastolic BP differences were less clinically significant. UTUVA demonstrated higher use of all five conventional antihypertensive categories than TUVA (p ≤ .02 for all categories).

CONCLUSIONS

In the early years of older adulthood, the 1940-born cohort showed a positive trend in hypertension management, yet maintained a 74.3% baseline rate of uncontrolled BP. Furthermore, by the ages 81-82, the benefits observed over the 1920-born cohort had lessened, influenced by the COVID-19 pandemic or other lasting factors. Heightened efforts to improve hypertension treatment in older adults remain crucial in the post-HYVET era.

Involvement of AGE and Its Receptors in the Pathogenesis of Hypertension in Elderly People and Its Treatment

Both systolic and diastolic blood pressures increase with age up to 50 to 60 years of age. After 60 years of age systolic pressure rises to 84 years of age but diastolic pressure remains stable or even decreases. In the oldest age group (85-99 years), the systolic blood pressure (SBP) is high and diastolic pressure (DBP) is the lowest. Seventy percent of people older than 65 years are hypertensive. This paper deals with the role of advanced glycation end products (AGE) and its cell receptor (RAGE) and soluble receptor (sRAGE) in the development of hypertension in the elderly population. Plasma/serum levels of AGE are higher in older people as compared with younger people. Serum levels of AGE are positively correlated with age, arterial stiffness, and hypertension. Low serum levels of sRAGE are associated with arterial stiffness and hypertension. Levels of sRAGE are negatively correlated with age and blood pressure. Levels of sRAGE are lower in patients with arterial stiffness and hypertension than patients with high levels of sRAGE. AGE could induce hypertension through numerous mechanisms including, cross-linking with collagen, reduction of nitric oxide, increased expression of endothelin-1, and transforming growth factor-β (TGF-β). Interaction of AGE with RAGE could produce hypertension through the generation of reactive oxygen species, increased sympathetic activity, activation of nuclear factor-kB, and increased expression of cytokines, cell adhesion molecules, and TGF- β. In conclusion, the AGE-RAGE axis could be involved in hypertension in elderly people. Treatment for hypertension in elderly people should be targeted at reduction of AGE levels in the body, prevention of AGE formation, degradation of AGE in vivo, downregulation of RAGE expression, blockade of AGE-RAGE interaction, upregulation of sRAGE expression, and use of antioxidants.

The Prevalence of Anticitrullinated Protein Antibodies in Older Poles-Results from a Population-Based PolSenior Study

Little is known about the occurrence of antibodies in older subjects. We analyzed the prevalence of anticitrullinated protein antibodies (anti-CCP) in a representative cohort of Polish older adults, participants of PolSenior substudy. Randomly selected 1537 serum samples of community-dwelling participants aged 65 and over. Questionnaires were completed by qualified interviewers and laboratory assessments served as a database for this analysis. The frequency of anti-CCP seropositivity (N = 50) was estimated at 3.25% (95% CI: 2.45-4.30%), being higher among women-4.05% (2.83-5.73%) than men-2.41% (1.48-3.86%). The frequency of anti-CCP seropositivity was decreasing with age from 4.29% in aged 65-74 years and 4.07% in 70-84 years to 1.50% in aged 85 years or above (p < 0.05). Hypoalbuminemia, inflammatory status (C-reactive protein >10 mg/dL or interleukin-6 ≥10 pg/mL), and female gender were associated with increased, while age ≥85 years with decreased risk of seropositivity. Multivariable logistic regression revealed that hypoalbuminemia, inflammatory status, and age ≥85 years were independently associated factors of anti-CCP seropositivity. The decreased frequency of anti-CCP seropositivity in the oldest old suggests shorter survival of the seropositive individuals who developed rheumatoid arthritis. It seems that low symptomatic RA remains frequently undiagnosed in older subjects.

Prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia, and associated risk factors in the Czech Republic, Russia, Poland and Lithuania: a cross-sectional study

Background

Empirical evidence on the epidemiology of hypertension, diabetes and hypercholesterolemia is limited in many countries in Central and Eastern Europe. We aimed to estimate the prevalence, awareness, treatment and control of hypertension, diabetes and hypercholesterolemia in the Czech Republic, Russia, Poland and Lithuania, and to identify the risk factors for the three chronic conditions.

Methods

We analysed cross-sectional data from the HAPIEE study, including adults aged 45–69 years in the Czech Republic, Russia, Poland and Lithuania, collected between 2002 and 2008 (total sample N = 30,882). Among prevalent cases, we estimated awareness, treatment, and control of hypertension, diabetes and hypercholesterolemia by gender and country. Multivariate logistic regression was applied to identify associated risk factors.

Results

In each country among both men and women, we found high prevalence but low control of hypertension, diabetes, and hypercholesterolemia. Awareness rates of hypertension were the lowest in both men (61.40%) and women (69.21%) in the Czech Republic, while awareness rates of hypercholesterolemia were the highest in both men (46.51%) and women (51.20%) in Poland. Polish participants also had the highest rates of awareness (77.37% in men and 79.53% in women), treatment (71.99% in men and 74.87% in women) and control (30.98% in men and 38.08% in women) of diabetes. The common risk factors for the three chronic conditions were age, gender, education, obesity and alcohol consumption.

Conclusions

Patterns of awareness, treatment and control rates of hypertension, diabetes and hypercholesterolemia differed by country. Efforts should be made in all four countries to control these conditions, including implementation of international guidelines in everyday practice to improve detection and effective management of these conditions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13260-3.

Increased risk of death compared to other antipsychotics in elderly clozapine users in Poland

Clozapine can cause severe adverse effects. Few epidemiologic studies have considered the effect of clozapine use in elderly patients. The aim of this study was to assess mortality in elderly patients treated with clozapine in comparison to patients treated with first- or second-generation antipsychotics. We conducted a retrospective cohort study involving 26 639 patients who were 65 years of age or older and were receiving antipsychotic medication between 2008 and 2012. Cox proportional-hazards models were used to compare the risk of death between different groups of antipsychotics after controlling for age, sex, concomitant treatment with cardiovascular or metabolic medications. The use of antipsychotic medications other than clozapine was associated with a lower adjusted risk of death [hazard ratio, 0.89; 95% confidence interval (95% CI), 0.79-0.99]. The use of cardiac and antilipemic but not antidiabetic drugs was associated with a significantly lower risk of death in this population (hazard ratio, 0.88; 95% CI, 0.83-0.93; hazard ratio, 0.66; 95% CI, 0.58-0.75 and hazarad ratio, 1.09; 95% CI, 0.96-1.24, respectively). These results suggest that clozapine is associated with an increased risk of death in the elderly. Although the study was based on administrative records linkage, its results suggest that attention should be paid to patients taking antipsychotics.

Twenty-Year Mortality Trends in Patients with Kidney Disease in Poland with the Use of the Years of Life Lost Measure, 2000-2019

Due to the significant socioeconomic burden of kidney diseases, we decided to analyse years of life lost (YLLs) from this cause in Poland between the years 2000 and 2019. The standard expected years of life lost (SEYLL) measure was used to calculate the number of YLLs, the value of which was related to the size of the study population and calculated per 100,000 persons (SEYLLp). A time trend analysis was performed using the Joinpoint regression method. In 2000, the number of YLLs for the entire population was 72,795 (SEYLLp = 190.3 years). After a period of minor changes between 2000 and 2011 (increasing at 0.9% per year), the YLL index rapidly declined between 2011 and 2015 (at −15.4% yearly) and then increased in the last years of the study period (at 12.5% yearly). These changes resulted in a decrease in the number of YLLs to 57,278 in 2019 (SEYLLp = 149.2). The deteriorating health status of Poles after 2015 most likely was caused by the aging of the population, as well as the increasing incidence of risk factors, in particular diabetes and arterial hypertension.

Coexistence of cardiovascular risk factors and obstructive sleep apnoea in polysomnography

OBJECTIVES

The objective of the study was to assess the relationship between the coexistence of cardiovascular risk factors (CVRFs) and the incidence and severity of obstructive sleep apnoea (OSA).

METHODS

The study involved 88 people, aged 53.76 ± 12.59 years. A questionnaire, basic anthropometric measurements, blood pressure, standard laboratory tests (total cholesterol, triglycerides and glucose) and polysomnography were performed. Each patient was assessed for the presence of CVRFs: i.e. obesity, arterial hypertension, hypercholesterolemia, hypertriglyceridemia, type 2 diabetes and smoking. OSA was diagnosed based on the apnoea and hypopnea index (AHI) in polysomnography.

RESULTS

It was documented that the mean AHI values were significantly higher in obese patients than in non-obese patients, in patients with arterial hypertension than in patients without hypertension, in patients with hypercholesterolaemia than in patients without hypercholesterolaemia and in patients declaring smoking than in non-smoking patients. The correlation analysis revealed a significant positive linear relationship between the number of CVRFs and the AHI value in polysomnography (r = 0.40, p < 0.05). Based on the regression analysis, it was documented that obesity, arterial hypertension and smoking are independent predictors of higher AHI values.

CONCLUSIONS

In the study group of patients with multiple cardiovascular risk factors, there is a directly proportional relationship between the number of cardiovascular risk factors and the AHI index in polysomnography.

Transient Global Amnesia - Risk Factors and Putative Background

Objectives

Transient global amnesia (TGA) is a temporary short-term reversible memory loss. Etiology of TGA remains unclear with various hypotheses. We analyzed clinical characteristics, neuroimaging, and electrophysiological findings as well as comorbidities and seasonal variation in TGA patients with regard to possible background of the syndrome.

Materials and Methods

A total of 56 patients (42 women and 14 men) with TGA hospitalized from 2008 to 2016 in the Department of Neurology, Wrocław Medical University.

Results

A total of 52 patients (92.9%) underwent their first-ever episode of TGA. The potential triggers or events before episode could be recognized in 22 patients (39.3%). 35.7% patients had TGA in summer and 26.8% in winter months. In 92.9% patients chronic diseases were found, included: Hypertension (60.7%), dyslipidemia (48.2%), autoimmune thyroiditis (17.9%), and ischemic heart disease (14.3%). One patient (1,8%) suffered from migraine. Doppler ultrasonography of carotid arteries revealed abnormalities in 29 patients (51.8%). Electroencephalography abnormalities were observed in 10 (17.6%) of patients.

Conclusion

Our findings suggest a putative cerebrovascular background of transient global amnesia. No evidence has been provided for the association between TGA and epilepsy or migraine. Among comorbidities, autoimmune thyroiditis deserves further investigation with regard to its potential links with TGA.

Prevalence of Hyperuricemia and the Use of Allopurinol in Older Poles-Results from a Population-Based PolSenior Study

BACKGROUND

Our study analyzes the frequency and risk factors of hyperuricemia and the use of allopurinol in a representative cohort of the older Polish adult population.

METHODS

The analysis was a part of a cross-sectional PolSenior study on aging in Poland. The complete medication data were available in 4873 out of 4979 community dwelling respondents aged 65 and over. Serum uric acid concentrations were evaluated in 4028 participants (80.9% of the cohort).

RESULTS

Hyperuricemia was observed in 28.2% of women and 24.7% of men. Ten risk factors of hyperuricemia were selected based on multivariable LASSO logistic regression analysis. Nine factors showed significant odds ratios: eGFR < 60 mL/min/1.73 m2 (OR = 4.10), hypertriglyceridemia (OR = 1.88), obesity (OR = 1.75), heart failure (1.70), CRP > 3.0 mg/dL (OR = 1.64), coronary artery disease (OR = 1.30), use of loop-diuretics (OR = 4.20), hydrochlorothiazide (OR = 2.96), and thiazide-like diuretics (OR = 2.81). Allopurinol was used by 2.8% of men and 1.8% of women. The therapy was considered effective in 46.7% of men and 53.3% of women.

CONCLUSIONS

Hyperuricemia was present in 23.1% (95% CI: 21.8-24.4) of the older Polish population. The frequency of hyperuricemia increases with age, reaching 30.5% in men and 33.7% in women aged 90 years or more. Chronic kidney disease, obesity, heart failure, hypertriglyceridemia, and the use of diuretics were the strongest risk factors for hyperuricemia in older adults. The treatment with allopurinol was ineffective in more than half of participants.

Prevalence, awareness, treatment, and control of hypertension in older people: results from the population-based KORA-age 1 study

Background

Hypertension remains a significant modifiable risk factor for cardiovascular diseases and a major determinant of morbidity and mortality. We aimed to describe sex-stratified age-standardized estimates of prevalence, awareness, treatment and control of hypertension, and their associated factors in older adults.

Methods

The KORA-Age1 is a population-based cross-sectional survey carried out in 2008/2009 on individuals aged 65–94 years in Augsburg region, Germany. Blood pressure measurements were available for 1052 out of 1079 persons who participated in the physical examination. Factors associated with prevalence, awareness and control of hypertension were investigated by multivariable logistic regression.

Results

The overall prevalence of hypertension (≥140/90 mmHg) was 73.8% [95% confidence interval (CI), 69.3–77.9], representing 74.8% (95% CI, 68.4–80.2) in men and 73.5% (95% CI, 66.8–79.3) in women. Among those with hypertension, 80.2% (95% CI, 75.3–84.4) were aware of their hypertensive condition and 74.4% (95% CI, 69.2–79.1) were on treatment for hypertension. Among those aware of their hypertension status, 92.8% (95% CI, 88.8–95.6) were on treatment and 53.7% (95% CI, 47.0–60.1) had their blood pressure controlled. Hypertension was more frequent in individuals who were older, obese, or had diabetes. Higher education attainment or presence of comorbidities was associated with higher level of hypertension awareness. Individuals taking three antihypertensive drug classes were more likely to have controlled hypertension compared with those taking one antihypertensive drug class, odds ratio (OR), 1.85 (95% CI, 1.14–2.99).

Conclusion

Our findings identified high prevalence of hypertension and relevant health gaps on awareness, treatment and suboptimal control of hypertension in older adults in Germany. Screening for hypertension should especially target older adults with low educational attainment and ‘healthy’ elderly with less contact to physicians.

Prevalence of Systemic Arterial Hypertension Diagnosed, Undiagnosed, and Uncontrolled in Elderly Population: SABE Study

Systemic arterial hypertension is the most prevalent chronic noncommunicable disease among older people. This study aimed to estimate the prevalence of hypertension in the elderly and to analyze factors associated with diagnosed, undiagnosed, and uncontrolled hypertension. This is a cross-sectional study of data from the SABE study—Health, Well-Being, and Aging Survey—a multiple-cohort study, obtained in 2010, composed of a probabilistic sample representative of the population of the São Paulo city aged ≥60 years. Hypertension was self‐reported or defined by increased blood pressure. Multinomial regression assessed factors associated with diagnosis and lack of diagnosis of hypertension (reference: no hypertension), and logistic regression assessed factors associated with uncontrolled hypertension (reference: controlled). The prevalence of hypertension was 79.5%, and in 51% of individuals with the condition, hypertension was uncontrolled. Undiagnosed hypertension was associated with nonwhite skin color (OR: 1.89, CI: 1.11–3.19), being uninsured (OR: 1.77, CI: 1.04–3.03), overweight (OR: 2.38, CI: 1.09–5.19), higher education (OR: 0.46, CI: 0.22–1.94), and ≥1 chronic disease (OR: 0.28; CI: 0.13–0.58). Diagnosed hypertension was associated with age between 70 and 79 years (OR: 2.02, CI: 1.34–3.05), age ≥80 (OR: 2.73, CI: 1.72–4.31), nonwhite skin color (OR: 1.48, CI: 1.01–2.18), being uninsured (OR: 1.70, CI: 1.18–2.47), at least one medical consultation in the last year (OR: 1.86, CI: 1.06–3.25), obesity (OR: 2.50, CI: 1.61–3.88), and ≥1 chronic disease (OR: 2.81, CI: 1.94–4.08). Among those with hypertension, being uncontrolled was associated with widowhood (OR: 1.73, CI: 1.23–2.43), being uninsured (OR: 1.38, CI: 1.02–1.87), and female gender (OR: 0.61, CI: 0.43–0.87). The prevalence of hypertension was high in this population, and its diagnosis and control were associated with socioeconomic, demographic, and healthcare access factors.

CA125 as a Marker of Heart Failure in the Older Women: Population-Based Analysis

(1) Background: Cancer antigen 125 (CA125) is a glycoprotein that is expressed by tissue derived from coelomic epithelium in the pleura, peritoneum, pericardium. It has been shown that CA125 concentrations are correlated with NT-proBNP in older people with congestive heart failure (HF). We conducted a study on the association between concentrations of CA125 and NT-proBNP in a population-based cohort of older Polish women. (2) Methods: The current research is sub-study of a large, cross-sectional research project (PolSenior). The study group consisted of 1565 Caucasian women aged 65–102 years. To assess the relationship between CA125 and other variables a stepwise backward multivariate normal and skew-t regression analyses were performed. (3) Results: The median of CA125 concentration was 13.0 U/mL and values over the upper normal range limit (35 U/mL) were observed in 5.1% (n = 79) of the study cohort. The concentration of CA125 was positively related to age, hospitalization for HF and history of atrial fibrillation and chronic obstructive pulmonary disease, levels of NT-proBNP, IL-6, hs-CRP and triglycerides. We found in the multivariate analyses, that increased CA125 levels were independently associated with log₁₀ (IL-6) (β = 11.022), history of hospitalization for HF (β = 4.619), log₁₀ (NT-proBNP) (β = 4.416) and age (β = 3.93 for 10 years). (4) Conclusions: Despite the association between CA125 and NT-proBNP, the usefulness of CA125 for the detection of HF in older women is limited by factors such as inflammatory status and age.

Do we know more about hypertension in Poland after the May Measurement Month 2017?-Europe

Elevated blood pressure (BP) is a worldwide burden, leading to over 10 million deaths yearly. May Measurement Month (MMM) is a global initiative organized by the International Society of Hypertension aimed at raising awareness of hypertension and the need for BP screening. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. BP measurement, the definition of hypertension and statistical analysis followed the globally approved MMM17 Study Protocol. In Poland 5834 (98.9%, Caucasian) individuals were screened. After multiple imputation, 2601 (35.3%) had hypertension. Of individuals not receiving anti-hypertensive medication, 976 (20.6%) were hypertensive. Of individuals receiving anti-hypertensive medication, 532 (49.1%) had uncontrolled BP. In the crude screened group, 81.4% declared to not receive any anti-hypertensive treatment, while the remaining 18.6% were on such medications. In overweight and obese patients both systolic and diastolic BP were significantly higher than in normal weight and underweight subjects. In addition, BP measured on Sundays was significantly lower than on Mondays. MMM17 was one of the largest recent BP screening campaigns in Poland. We found that over 1/3 of participants were hypertensive. Almost half of the treated subjects had uncontrolled BP. These results suggest that opportunistic screening can identify substantial numbers with raised BP.

Hypertension Prevalence, Treatment and Control in Older Adults in a Brazilian Capital City

BACKGROUND

The diagnosis, treatment and control of arterial hypertension are fundamental for a reduction in cardiovascular outcomes, especially in the elderly. In Brazil, there are few studies that specifically identified these rates in the elderly population.

OBJECTIVE

To verify rates of prevalence, treatment and control of hypertension in elderly people living in the urban area of a Brazilian capital city.

METHODS

A cross-sectional, population-based, randomized, cluster-based study with 912 non-institutionalized elderly individuals (≥ 60 years), living in urban areas in the city of Goiania, Midwest Brazil. Predictor variables were: age, gender, socioeconomic and lifestyle aspects. Blood pressure measurements were performed at home; patients were considered as having arterial hypertension when SBP and/or DBP ≥ 140/90 mmHg or when using antihypertensive drugs (dependent variable). Rates of hypertension treatment and control were evaluated. Variable association analyses were performed by multivariate logistic regression and level of significance was set at 5%.

RESULTS

The prevalence of arterial hypertension was 74.9%, being higher (78.6%) in men (OR 1.4, 95% CI: 1.04-1.92); the treatment rate was 72.6%, with higher rates being observed in smokers (OR 2.06, 95% CI: 1.28-3.33). The rate of hypertension control was 50.8%,being higher in women (OR 1.57, 95% CI: 1.19-2.08).

CONCLUSION

The prevalence rates were high. Treatment and control rates were low and associated with gender, age and lifestyle, indicating the need for early and individual interventions.

Hypertension prevalence in early breast cancer patients undergoing primary surgery

PURPOSE

Treatment with chemotherapy and targeted drugs may results in elevated risk of cardiac and renal toxicity as well as hypertension. However, data on prevalence of chronic kidney disease and hypertension in subjects with early breast cancer undergoing primary surgery are very limited.

PATIENTS AND METHODS

The study aimed to assess the prevalence of chronic kidney disease and hypertension (evaluated as a preoperative assessment and defined according to ESC/ESH guidelines) in a cohort of 100 consecutive female patients with early breast cancer treated with primary surgery with curative intent.

RESULTS

Patients with breast cancer were 53 ± 14 years of age, with serum creatinine of 0.68 ± 0.14 mg/dl and estimated glomerular filtration rate by chronic kidney disease-epidemiological collaboration formula of 99 ± 18 mL/min/1.72 m². Hypertension was present in 37%, but in the elderly patients (over 65 years) the prevalence was 74%. Hypertensive females had worse kidney function as reflected by higher serum creatinine and lower estimated glomerular filtration rate, higher body mass index and fibrinogen, which reflects general inflammatory state. When we divided the patients according to age (≤ vs >65 years) and the presence of hypertension, the elderly hypertensive females had significantly worse kidney function, higher fibrinogen and fasting glucose.

CONCLUSIONS

The prevalence of hypertension in patients with breast cancer raises with age, and presence of comorbidities, including chronic kidney disease. Hypertension should be treated promptly to prevent cardiovascular complications during oncological therapy.

Obesity Paradox in Caucasian Seniors: Results of the PolSenior Study

OBJECTIVES

To investigate the influence of overweight and obesity on general performance and mortality in seniors.

DESIGN

Cross-sectional multidisciplinary study on ageing of the Polish population.

SETTING

Community-dwelling individuals aged 65 years or older, selected using three-stage stratified, proportional draw.

PARTICIPANTS

4944 Polish Caucasian seniors, aged 65 years or older recruited between October 2007 and October 2010.

MEASUREMENTS

All study subjects underwent measurement of body mass index (BMI), waist circumference (WC), and arm circumference (AC). The physical and cognitive performance was evaluated using the Katz Activities of Daily Living (ADL) score and Mini-Mental State Examination (MMSE), respectively. Morbidity data were obtained from a medical questionnaire. Mortality data were obtained from the Population Register of Poland between October 2015 and October 2018.

RESULTS

Increasing age was associated with a decreased prevalence of obesity (all p<0.001). Higher BMI, WC and AC values were associated with higher ADL and MMSE scores (all p<0.001). On multivariate analysis, all three body measurements in women remained independent predictors of the ADL score (BMI p=0.002, WC p=0.005, AC p<0.001) and MMSE score (p<0.001, p=0.003, p<0.001). In men, physical functioning was associated with AC (p=0.003), and cognitive status was associated with AC (p<0.001) and BMI (p=0.013). There was no association between general obesity, abdominal obesity, or AC with several aging-related adverse conditions. Kaplan-Meier survival curves showed that overweight and obesity were associated with the lowest mortality. On multivariate analysis, BMI and AC values remained independent predictors of mortality. In successfully aging individuals, neither BMI, WC, nor AC remained such predictors.

CONCLUSIONS

Overweight and obesity in Caucasian seniors are not associated with deterioration of physical and cognitive function or with increased mortality.

Components of metabolic syndrome in relation to plasma levels of retinol binding protein 4 (RBP4) in a cohort of people aged 65 years and older

PURPOSE

Elevated plasma concentration of retinol binding protein 4 (RBP4) has recently emerged as a potential risk factor as a component of developing metabolic syndrome (MS). Therefore, this study aimed to analyse the relationship between components of MS and concentrations of plasma RBP4 in a population of subjects 65 years and older.

METHODS

The study sample consisted of 3038 (1591 male) participants of the PolSenior study, aged 65 years and older. Serum lipid profile, concentrations of RBP4, glucose, insulin, C-reactive protein, IL-6, and activity of aminotransferases were measured. Nutritional status (BMI/waist circumference) and treatment with statins and fibrates were evaluated. Glomerular filtration rate (eGFR), de Ritis ratio, and fatty liver index (FLI), as well as HOMA-IR were calculated.

RESULTS

Our study revealed a strong relationship between components of MS and RBP4 in both sexes: plasma RBP4 levels were increased in men by at least 3×, and in women by at least 4×. Hypertriglyceridemia was most strongly associated with elevated plasma RBP4 levels. Multivariate, sex-adjusted regression analysis demonstrated that chronic kidney disease [OR 1.86 (95% CI 1.78-1.94)], hypertriglyceridemia [OR 1.52 (1.24-1.87)], hypertension [OR 1.15 (1.12-1.19)], low serum HDL cholesterol [OR 0.94 (0.92-0.97)], and age > 80 years [OR 0.86 (0.81-0.90)] were each independently associated with RBP4 concentration (all p < 0.001).

CONCLUSIONS

In Caucasians 65 years and older, RBP4 serum levels are associated with a number of components of MS, independent of sex and kidney function. Hypertriglyceridemia as a component of MS is most significantly related to RBP4 concentration.

Oriental herbal medicine for insomnia in the elderly with hypertension: A systematic review protocol

BACKGROUND

Hypertension and insomnia are common diseases in the elderly. Oriental herbal medicine has been widely used in East Asia, and it has been considered as a promising alternative to conventional pharmacotherapy because of its efficacy in geriatrics. Moreover, since oriental herbal medicine acts on multiple targets, it may affect both hypertension and insomnia at the same time, which can reduce the risk of polypharmacy in this population. This systematic review will assess the efficacy and safety of oriental herbal medicine in the elderly with both insomnia and hypertension.

METHODS

Thirteen databases including English, Chinese, Korean, and Japanese databases will be searched from their inception to August 2018. We will include randomized controlled trials assessing oriental herbal medicine for insomnia in the elderly with hypertension. The methodological quality of the included studies will be evaluated using the Cochrane Collaboration's risk of bias tool, and confidence in the cumulative evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation instrument.

RESULTS

This review will provide evidence to determine the efficacy and safety of oriental herbal medicine in the elderly with both insomnia and hypertension.

CONCLUSIONS

Our results will help clinicians and health policy makers take informed decisions regarding the use of oriental herbal medicine in the elderly. It will also provide evidence-based oriental herbal medicine data for elderly patients suffering from multiple diseases and their families.

Self-rated health and its association with all-cause mortality of older adults in Poland: The PolSenior project

OBJECTIVES

Predictive effect of self-rated health (SRH) on mortality in older adults has been observed. The purpose of the study was to analyze this association in Poles aged 65+.

METHODS

Data were obtained from the nationwide, multidisciplinary PolSenior project, conducted in a representative sample of older population. The study group comprised 4049 respondents (48.0% women) without significant cognitive deficit. SRH was measured using Visual Analog Scale. The analysis included selected socio-economic, health status and life-style factors. Mortality data were retrieved from the state registry.

RESULTS

During 5-year period, 414 women (21.4%) and 672 men (31.8%) have died, including 17.5% of women and 26.6% of men with good, 21.6% and 32.9% with fair, 36.2% and 55.3% with poor SRH, respectively. Kaplan-Meier survival curves for SRH revealed significant differences for both genders. Univariate Cox regression analysis revealed significant hazard ratios (HRs) for mortality among women and men with poor compared to good SRH [2.48 (1.83-3.37); 2.62 (2.04-3.36), respectively] and those with fair compared to good SRH [1.29 (1.03-1.60); 1.29 (1.10-1.52), respectively]. Age-adjusted HRs for mortality were significant between groups with poor and good SRH [women: 1.98 (1.46-2.68), men: 2.06 (1.60-2.64)]. Multivariate Cox proportional hazard regression model including revealed significant HRs for mortality between women with poor and good SRH [1.67 (1.06-2.64)].

CONCLUSIONS

SRH was associated with mortality in both genders. After adjustment for age, this relationship was maintained in respondents with poor compared to good SRH. Inclusion of potential confounders demonstrated that SRH was an independent predictor of mortality only in women.

Plasma Level of Retinol-Binding Protein 4, N-Terminal proBNP and Renal Function in Older Patients Hospitalized for Heart Failure

BACKGROUND/AIM

Elevated plasma concentration of retinol-binding protein 4 (RBP4) has recently emerged as a potential new risk factor for cardiovascular diseases, including hypertension (HT) and coronary artery disease (CAD). Limited data suggest that RBP4 promotes inflammatory damage to cardiomyocytes and participates in the development of heart failure (HF). This study aimed to analyze the relationship between concentrations of plasma RBP4 and serum N-terminal proBNP (NT-proBNP), a powerful biomarker of left ventricle dysfunction, in the older Polish population.

METHODS

The study sample consisted of 2,826 (1,487 men) participants of the PolSenior study, aged 65 years and older, including a subgroup hospitalized for HF (n = 282). In all subjects, plasma concentrations of RBP4, interleukin-6 (IL-6), serum level of NT-proBNP, and hs-CRP were measured. Additionally, BMI, estimated glomerular filtration rate (eGFR), and HOMA-IR were calculated. The prevalence of HT, CAD, atrial fibrillation (AF), and medication were considered as potential confounders.

RESULTS

Similar RBP4 levels were found in subjects with NT-proBNP < 125 and ≥125 ng/mL, with and without AF, and in the subgroups hospitalized for HF with and without AF. Regression analysis revealed no association between log10(NT-proBNP) and log10(RBP4). Plasma levels of RBP4 were increased by HT occurrence and diuretic therapy, while diminished with regard to female gender, age, eGFR values, AF, and IL-6 levels.

CONCLUSION

Our results show that RBP4 is affected by GFR but cannot be considered as an independent biomarker of heart muscle dysfunction.

Prevalence and control of hypertension among a Community of Elderly Population in Changning District of shanghai: a cross-sectional study

BACKGROUND

Hypertension is considered a major public health challenge. It is the most important risk factor for cardiovascular disease and is a prominent risk for China's elderly population. However, few studies have addressed the effect of blood pressure control on elderly hypertension patients in China. In response, this study aimed to investigate the prevalence and control of hypertension in the elderly population in Shanghai's communities.

METHODS

A secondary data analysis based on a government-financed health check-up program for an elderly population aged 65 and older from 2012 to 2014 was conducted in a central district of Shanghai.

RESULTS

Of the 44,978 study participants, 20,305 (45.1%) were males and 24,673 (54.9%) were females. The participants' median age was 72. Half of the participants were overweight or obese (BMI ≥ 24.0 kg/m2). The prevalence of hypertension was 59.9%. In the 18,032 participants without prior diagnosis of hypertension, 5530 (30.7%) had increased blood pressure. Among the 26,946 confirmed hypertension patients, the proportions of treatment and blood pressure control were 32.8% and 43.4% respectively. Multivariate analysis showed that the uncontrolled hypertension was significantly associated with older age, being overweight or obese, a lower level of education, an unbalanced dietary pattern, regular drinking and non-comorbidities.

CONCLUSIONS

The prevalence of hypertension was high in China's elderly population. The proportion of individuals who received treatment remained low, and blood pressure control was poor among hypertension patients. These results indicate that improvement of the ability to manage and control hypertension among urban elderly residents is urgently needed.

Prevalence, awareness, treatment, and control of hypertension among very elderly Chinese: results of a community-based study

The epidemiologic distribution of hypertension among very elderly Chinese is still not clear. This study aimed to investigate the prevalence, awareness, treatment, and control rate of hypertension among very elderly in Chengdu. From May 2013 to May 2015, a total of 1056 participants from 20 residential communities were sampled. Standard face-to-face interviews, physical examinations, and biochemical analysis were undertaken. Participants had a mean age of 83.6 ± 3.4 years (range: 80-100), and 49.8% were men. Mean systolic blood pressure (BP) and diastolic BP were 146.4 ± 20.6 and 74.1 ± 11.9 mm Hg, respectively, and both of the highest BP levels were among participants aged 80-84 years. Mean pulse pressure was 72.5 ± 17.1 mm Hg, and the highest pulse pressure level was among participants aged 90 years and older. The overall estimated hypertension prevalence was 75.3% (95% confidence interval: 72.6%-77.9%), and among overall participants, 51.9% were aware of their hypertensive condition and 45.5% were treated. However, only 18.1% of hypertensive participants were controlled (BP < 140/90 mm Hg). Among very elderly Chinese in Chengdu, the prevalence of hypertension is predominantly high, whereas awareness, treatment, and control rates are considerably low. Effective primary and secondary prevention strategies are needed.

Increased plasma RBP4 concentration in older hypertensives is related to the decreased kidney function and the number of antihypertensive drugs-results from the PolSenior substudy

Increased plasma retinol-binding protein 4 (RBP4), a novel adipokine, has been associated in previous studies with obesity, type 2 diabetes, dyslipidemia, hypertension (HT), atherosclerosis, and coronary artery disease. This study aimed to analyze the relationship between HT occurrence and its treatment, and plasma RBP4 concentrations in the older polish population. The study sample consisted of 1728 (890 men and 838 women) PolSenior study participants aged 65 years and older with available plasma samples and NT-proBNP values below 2000 pg/mL. The analysis included body mass index, waist circumference, blood pressure, antihypertensive medication, estimated glomerular filtration rate, serum glucose and insulin (and the homeostatic model assessment of insulin resistance), and plasma RBP4 levels. RBP4 plasma concentrations were higher in hypertensive (N = 645) than normotensive (N = 236) men (43.4 [30.4-64.8] vs. 38.1 [27.1-54.4] ng/mL, respectively; P < .01) but not in women (44.6 [29.6-63.5] vs. 40.7 [29.1-58.1] ng/mL, respectively; P = .21). In the subanalysis, higher plasma RBP4 levels were observed in women with treated than untreated HT and in subjects taking four of more antihypertensive drugs. The linear regression shown that estimated glomerular filtration rate (β = -0.015), thiazide diuretics (β = 0.041), and α-blockers (β = 0.049) were explaining log₁₀RBP4 plasma levels variability in the study group. Older male Caucasians with HT are characterized by elevated plasma RBP4 levels. This increase is proportional to the number of antihypertensive drugs and decreased glomerular filtration rate. Among the antihypertensive drugs, only thiazide diuretics and α-blockers had a significant influence on RBP4 levels.