Optimal treatment of hypertension in the elderly: a Korean perspective

Functional status and its associated factors among community-dwelling older adults in rural Nepal: findings from a cross-sectional study

BACKGROUND

The high burden of chronic conditions, coupled with various physical, mental, and psychosocial changes that accompany the phenomenon of aging, may limit the functional ability of older adults. This study aims to assess the prevalence of poor functional status and investigate factors associated with poor functional status among community-dwelling older adults in rural communities of eastern Nepal.

METHODS

Data on 794 older adults aged ≥ 60 years from a previous community-based cross-sectional study was used. Participants were recruited from rural municipalities of Morang and Sunsari districts of eastern Nepal using multi-stage cluster sampling. Functional status was assessed in terms of participants' ability to perform activities of daily living using the Barthel Index. Covariates included sociodemographic characteristics, lifestyle factors, and self-reported chronic conditions. A binary logistic regression model was used to investigate factors associated with poor functional status.

RESULTS

The overall prevalence of poor functional status was 8.3 % (male: 7.0 % and female: 9.6 %), with most dependence noted for using stairs (17.3 %), followed by dressing (21.9 %) on Barthel Index. In the adjusted model, oldest age group (odds ratio [OR] = 2.83, 95 %CI: 1.46, 5.50), those unemployed (OR = 2.41, 95 %CI: 1.26, 4.65), having memory/concentration problems (OR = 2.32, 95 %CI: 1.30, 4.13), depressive symptoms (OR = 2.52, 95 %CI: 1.28, 4.95), and hypertension (OR = 1.78, 95 %CI: 1.03, 3.06) had almost or more than two times poor functioning.

CONCLUSIONS

One in 12 older adults had poor functional status as indicated by their dependency on the items of the Barthel Index; those in the oldest age bracket were more likely to exhibit poor functional status. We suggest future studies from other geographies of the country to supplement our study from the rural setting for comprehensive identification of the problem, which could guide the development of prevention strategies and comprehensive interventions for addressing the unmet needs of the older adults for improving functional status.

Current status and therapeutic considerations of hypertension in the elderly

As the prevalence of hypertension in the elderly population is increasing, information regarding the characteristics, optimal blood pressure targets, and special considerations for elderly hypertensive patients is needed to improve clinical outcomes. Various factors should be considered when managing hypertension in elderly patients, and there are many controversial issues and conflicting results related to the optimal treatment of hypertension in the elderly. In this review, we provide an overview of the epidemiology and characteristics of elderly hypertensive patients and discuss the optimal treatment of hypertension in elderly people.

Association between Frailty and Hypertension Prevalence, Treatment, and Control in the Elderly Korean Population

Frailty is a common geriatric syndrome characterized by increased risk of disability, hospitalization, and mortality. Hypertension (HTN) is one of the most common chronic medical conditions in the elderly. However, there have been few studies regarding the association between frailty and HTN prevalence, treatment, and control rates. We analyzed data of 4,352 older adults (age ≥ 65 years) from the fifth Korea National Health and Nutrition Examination Survey. We constructed a frailty index based on 42 items and classified participants as robust, pre-frail, or frail. Of the subjects, 2,697 (62.0%) had HTN and 926 (21.3%) had pre-HTN. Regarding frailty status, 721 (16.6%), 1,707 (39.2%), and 1,924 (44.2%) individuals were classified as robust, pre-frail and frail, respectively. HTN prevalence was higher in frail elderly (67.8%) than pre-frail (60.8%) or robust elderly (49.2%) (P < 0.001). Among hypertensive patients, frail elderly were more likely to be treated than pre-frail or robust elderly (P < 0.001), but the proportion of patients whose blood pressure was under control ( < 150/90 mmHg) was lower in frail elderly (P = 0.005). Considering the adverse cardiovascular outcomes associated with frailty, more attention should be paid to the blood pressure control of the frail elderly.

Decrease in blood pressure and improved psychological aspects through meditation training in hypertensive older adults: A randomized control study

AIM

The present study aimed to evaluate the effects of Zen meditation on blood pressure (BP) and quality of life in elderly subjects.

METHODS

A total of 59 volunteers (21 men and 38 women), aged ≥60 years with systolic BP between 130 and 159 mmHg and diastolic BP between 85 and 99 mmHg, were randomly divided into a meditation group (MG), n = 28 and a control group (CG), n = 31. The MG meditated twice a day for 20 min for 3 months, and the CG remained on a waiting list. The BP levels were measured monthly in both groups. The volunteers' medication was kept stable. A quality of life assessment instrument was applied at the beginning and end of the study.

RESULTS

For systolic BP, analysis of variance showed the influence of time (F(4,228)  = 4.74, P < 0.01, β = 0.98) and the interaction group × time (F(4,228)  = 3.07, P < 0.01, β = 0.89). The MG showed a significant decrease in systolic BP levels in the second measurement after 1 month of meditation practice when compared with the CG (Newman-Keuls test, P < 0.05). Starting at the second measurement, systolic BP levels in the MG were lower than the baseline and first measurement levels; however, the systolic BP levels were similar to those observed in the CG. In the quality of life assessment evaluation, a significant improvement in psychological aspects and overall quality of life in the MG compared with the CG was observed.

CONCLUSION

These results suggest that Zen meditation is an interesting tool as a complementary treatment for hypertension in elderly subjects.

Blood Pressure Variability and Cognitive Function in the Elderly

With the increase in the aging population, it is important to understand the individual diseases and their interactions which are prevalent and have a great impact on the health status of the elderly. Hypertension is one of the most common diseases in older age and may impact the health status because it is the main risk factor for cardiovascular and cerebrovascular diseases such as heart failure and stroke. Recently, much evidence has been accumulated showing that hypertension plays an important role in the development and progression of cognitive impairment and dementia. Cerebral hypoperfusion secondary to severe atherosclerosis resulting from long-standing hypertension may be a major biological pathway linking high blood pressure (BP) to cognitive decline and dementia. Furthermore, increased BP variability has also been reported to be significantly associated with white matter hyperintensities and brain atrophy, which are predisposing conditions of dementia, depression, and falls in the elderly even after adjusting for BP levels and other confounding variables. Several mechanisms have been shown to be involved in the association between BP variability and cognitive impairment in elderly individuals. In addition to an increased cerebral blood flow fluctuation, neurohumoral activation, endothelial dysfunction, inflammation, and oxidative stress have been suggested to be the underlying mechanisms. However, clinical trials provide limited evidence for a protective effect of antihypertensive therapy against dementia and stroke-related cognitive decline. In this article, we aimed to review the existing evidence of the connection between BP variability and cognitive impairment in elderly people.