1
|
Chatzis DG, Magounaki K, Pantazopoulos I, Beltsios ET, Katsi V, Tsioufis KP. Current Management of Hypertension in Older Adults. Drugs Aging 2023; 40:407-416. [PMID: 36933178 DOI: 10.1007/s40266-023-01013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/19/2023]
Abstract
Hypertension is a major global health issue and it accounts for a big proportion of disability and mortality worldwide even in adults aged 65 years and above. Moreover, advanced age per se is an independent risk factor for adverse cardiovascular events and there is abundant scientific evidence supporting the beneficial effects of blood pressure lowering, within certain limits, in this subset of hypertensive patients. The aim of this review article is to summarize the available evidence regarding the appropriate management of hypertension in this specific subgroup, in an era of a constantly increasing aging population.
Collapse
Affiliation(s)
- Dimitrios G Chatzis
- Medical School, European University Cyprus, 76 Siggrou avenue, 11742, Athens, Greece.
| | - Kalliopi Magounaki
- Department of Internal Medicine, KAT General Hospital of Athens, Athens, Greece
| | - Ioannis Pantazopoulos
- Department of Emergency Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Eleftherios T Beltsios
- Department of Thoracic and Cardiovascular Surgery, West Germany Heart Center, University Clinic Essen, Essen, Germany
| | - Vasiliki Katsi
- Department of Cardiology, School of Medicine, Ηippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos P Tsioufis
- 1st Cardiology Clinic, School of Medicine, Ηippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
2
|
Yang JW. Blood Pressure Control in Elderly Chronic Kidney Disease Patients. Electrolyte Blood Press 2022; 20:57-63. [PMID: 36688210 PMCID: PMC9827045 DOI: 10.5049/ebp.2022.20.2.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
In elderly chronic kidney disease (CKD) patients, isolated systolic hypertension is common, the rate of renal function decline is slow, and there is a high possibility of physical damage due to side effects such as drug use-related orthostatic hypotension. Therefore, there are still many questions about whether lowering blood pressure in elderly patients will actually improve prognosis. Since many blood pressure-related clinical studies exclude advanced CKD and the elderly, it is particularly difficult to define target blood pressure in these populations. A randomized controlled trial is needed to establish optimal blood pressure targets and treatment strategies in elderly patients with CKD. This review seeks to summarize the guidelines available at this time.
Collapse
Affiliation(s)
- Jae Won Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.,The Korean Society of Geriatric Nephrology, Seoul, Republic of Korea
| |
Collapse
|
3
|
The Key Role of Ambulatory Blood Pressure Monitoring in the Detection of Masked Hypertension and Other Phenomena in Frail Geriatric Patients. Medicina (B Aires) 2021; 57:medicina57111221. [PMID: 34833439 PMCID: PMC8622895 DOI: 10.3390/medicina57111221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: This study aims to determine prevalence of masked uncontrolled hypertension (MUH) in frail geriatric patients with arterial hypertension and thus show the role of ambulatory blood pressure monitoring (ABPM) since hypertension occurs in more than 80% of people 60+ years and cardiovascular diseases are the main cause of death worldwide. Despite modern pharmacotherapy, use of combination therapy and normal office blood pressure (BP), patients’ prognoses might worsen due to inadequate therapy (never-detected MUH). Materials and Methods: 118 frail geriatric patients (84.2 ± 4.4 years) treated for arterial hypertension with office BP < 140/90 mmHg participated in the study. 24-h ABPM and clinical examination were performed. Results: Although patients were normotensive in the office, 24-h measurements showed that BP values in 72% of hypertensives were not in the target range: MUH was identified in 47 (40%) patients during 24 h, in 48 (41%) patients during daytime and nocturnal hypertension in 60 (51%) patients. Conclusions: ABPM is essential for frail geriatric patients due to high prevalence of MUH, which cannot be detected based on office BP measurements. ABPM also helps to detect exaggerated morning surge, isolated systolic hypertension, dipping/non-dipping, and set and properly manage adequate treatment, which reduces incidence of cardiovascular events and contributes to decreasing the financial burden of society.
Collapse
|
4
|
Zhao Y. Sports Enterprise Marketing and Financial Risk Management Based on Decision Tree and Data Mining. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:7632110. [PMID: 34691380 PMCID: PMC8536418 DOI: 10.1155/2021/7632110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/04/2021] [Indexed: 01/17/2023]
Abstract
With the development of modern economy, traditional sports industry enterprises have also been further developed in the financial business. How to ensure information security and financial risk management is the problem faced by sports companies. Risk assessment is the use of mathematical models to calculate the risk factors established in the previous step to predict possible risks. In response to the above problems, we developed a sports enterprise marketing and financial risk management model based on decision trees and data mining. First, we have established a relevant evaluation index system and data samples through in-depth understanding of the actual marketing and financial problems of sports companies. Second, we use the decision tree algorithm to mine and explore related data samples and conduct risk assessment through related indicators. By using the model to calculate the probability of occurrence of the risk, analyze the degree of damage. Finally, the algorithm of this paper is analyzed and discussed through simulation experiments.
Collapse
Affiliation(s)
- Yan Zhao
- School of Philosophy and Public Management, Henan University, Zhengzhou 475001, China
| |
Collapse
|
5
|
Abstract
Hypertension and hypotension are strictly related phenomena, that frequently coexist within the spectrum of cardiovascular autonomic dysfunction, especially at advanced age. Indeed, antihypertensive treatment may predispose to orthostatic and post-prandial hypotension, while intensive blood pressure lowering may be responsible for systemic hypotension. Over recent years, systemic and orthostatic hypotension have emerged as important although often neglected risk factors for adverse outcomes, paralleling the widely recognized arterial hypertension. Both hypertension and hypotension are associated with detrimental effects on target organs and survival, thus significantly impacting patients' prognosis, functional autonomy and quality of life. Balancing low and high blood pressure requires accurate diagnostic assessment of blood pressure values and patients' hypotensive susceptibility, which allow for the development of customized treatment strategies based on individual hypo/hypertensive risk profile. The present review illustrates the complex interrelationship between hypotension and hypertension and discusses the relevant prognostic role of these conditions. Additionally, it provides an overview on hypotension detection and treatment in patients with hypertension, focusing on customized diagnostic and therapeutic strategies.
Collapse
Affiliation(s)
- Giulia Rivasi
- Division of Geriatric and Intensive Care Medicine, Careggi Hospital and University of Florence, Florence, Italy -
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| |
Collapse
|
6
|
Abstract
Vascular aging leads to arterial hypertension, which is the leading cause of cardiovascular mortality and morbidity in older adults. Blood pressure reduction is effective in reducing the cardiovascular risk and is safe in ambulatory older adults. It is important to note that blood pressure control in this group of patients is challenging because of comorbidities, polypharmacy, and frailty. Choice of pharmacotherapy is not simple and should be individualized.
Collapse
Affiliation(s)
- Ozlem Bilen
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory Heart and Vascular Center, Atlanta, GA, USA.,Emory Women's Heart Center, Atlanta, GA, USA
| |
Collapse
|
7
|
Blood Pressure Measurements with Different Currently Available Methods in Elderly Hypertensive Hospitalized Patients: A Real World Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6274545. [PMID: 31058190 PMCID: PMC6463632 DOI: 10.1155/2019/6274545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/25/2019] [Accepted: 03/10/2019] [Indexed: 11/29/2022]
Abstract
Background The reliability of blood pressure (BP) measurement in hospitalized patients is a topic of debate and the therapeutic implication of the routinely collected BP profiles is probably overestimated. When measurements are performed in elderly patients, further potential sources of misinterpretation occur. Methods We conducted a subanalysis of a previous study including 79 over 80-year-old hypertensive patients, hospitalized in an internal medicine ward. Five modalities of BP evaluations (measurement by physicians and nurses, self-measurement by patients, Finometer® beat-to-beat finger monitoring, and 24h monitoring) were analyzed, considering agreement and accuracy. Results The mean (SD) age of the patients was 86.9±4.9 years (50% women). Patients' self-measurements of both systolic and diastolic BP (SBP and DBP) did not differ significantly from daytime 24-hour monitoring (D24hBPM) (mean difference -1.52, SE 1.71; p: ns and -0.58, SE 1.19 mmHg; p: ns). Conversely, SBP and DBP registered by nurses did significantly differ (mean difference -7.34, SE 1.42; p=0.007 and -4.7, SE 1.05 mmHg; p=0.003). SBP and DBP measured by patients also showed the better concordance, with lowest biases, and narrowest limits of agreements (LoA) and for SBP higher Kappa statistic values (bias 1.5, LoA -28.9 to 31.9; κ 0.563 and bias 0.6, LoA -20.4 to 21.5 mmHg; κ 0.412). The patients' sensitivity and specificity in predicting hypertensive systolic D24hBPM were 84.8% and 69.7%, respectively. Conclusions In elderly hospitalized patients an alternative to 24hBPM, self-measurements by patients offer the better agreement and reliability in detecting hypertensive values.
Collapse
|
8
|
Ozone S, Shaku F, Sato M, Takayashiki A, Tsutsumi M, Maeno T. Comparison of blood pressure measurements on the bare arm, over a sleeve and over a rolled-up sleeve in the elderly. Fam Pract 2016; 33:517-22. [PMID: 27402639 DOI: 10.1093/fampra/cmw053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although guidelines recommend that blood pressure (BP) should be measured on a bare arm, BP is sometimes measured over clothing in clinical settings. OBJECTIVE To assess the accuracy of BP measurements over clothing rolled up to the elbow in clinical settings. METHODS This was a cross-sectional study to a total of 186 individuals recruited from a primary care clinic and two day-care facilities between July and September 2014. Main outcome measures were BP measurements on (i) a bare arm, (ii) over the sleeve of a cardigan and (iii) over the sleeve of a cardigan rolled up to the elbow. BP was compared across measurement conditions using the paired t-test and multiple analysis of variance adjusting for age, sex, measurement order and interaction between clothing condition and measurement order. RESULTS Of 186 subjects, 38.5% were male. Mean age was 74.6 years. Mean BP with a bare arm, over a sleeve and over a rolled-up sleeve was 128.9 (SD 19.1)/67.4 (10.8) mmHg, 132.8 (21.0)/72.6 (11.5) mmHg and 133.4 (21.3)/74.4 (12.1) mmHg, respectively. There were significant differences in BP between the bare arm and over a cardigan sleeve (P < 0.001) and the bare arm and over a rolled-up cardigan sleeve (P < 0.001). BP differences were significant even after adjusting for age group, sex, measurement order and interaction between clothing condition and measurement order. CONCLUSIONS Although previous studies have suggested BP measurements over clothing are acceptable, our results suggest that BP should be measured on bare arms as recommended by guidelines whenever feasible.
Collapse
Affiliation(s)
- Sachiko Ozone
- Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan,
| | - Fumio Shaku
- Division of Respiratory Medicine, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan, Department of Psychosomatic Internal Medicine, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Mikiya Sato
- Kawakita Centre for Family Medicine, Kawakita General Hospital, Tokyo, Japan and Department of Health Services Research, University of Tsukuba, Tsukuba, Japan
| | - Ayumi Takayashiki
- Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Madoka Tsutsumi
- Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tetsuhiro Maeno
- Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
9
|
Mergeani AC, Antochi F, Rusu O, Ciobotaru A, Coclitu C, Bajenaru OA. Correlations of Cognitive Impairment with Circadian Blood Pressure Pattern and Intima-Media Thickness in Hypertensive Patients. MAEDICA 2015; 10:325-330. [PMID: 28465733 PMCID: PMC5394449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Cognitive impairment is strongly associated with arterial hypertension and might be associated also with certain circadian blood pressure patterns. Ambulatory blood pressure monitoring (ABPM) represents a very useful tool in the evaluation of patients with hypertension. Intima-media thickness (IMT), a marker of subclinical organ damage in hypertensive patients is associated with the progression of cognitive impairment. The aim of our study was to correlate the cognitive impairment with the hypertension pattern found with ABPM, IMT, lipid profile and inflammatory syndrome. MATERIALS AND METHODS We enrolled 40 patients aged between 47 and 88 years (69±11 years) with medical history of essential hypertension and cognitive impairment. All patients underwent neuropsychological examination, ABPM, and B-mode ultrasound of the carotid arteries. RESULTS 57% of the patients had a nondipping pattern. The blood pressure pattern inversely correlated with the results of MMSE (r=-0.33; p=0.04), patients with nondipping patterns having lower scores than the ones with dipper pattern. Increased IMT was associated with poorer performance on MoCA test (r=-0.33; p=0.005). MoCA and MMSE scores were inversely correlated with the total cholesterol (r=-0.31; p=0.04; and r=0.38; p=0.01 respectively) and with the LDL-cholesterol (r=-0.32; p=0.04; and r=-0.41; p=0.009 respectively). Patients with low scores on MMSE also had high serum levels of C reactive protein (r=-0.33; p=0.045). CONCLUSION Patients with cognitive impairment and hypertension have vascular changes characterized by increased carotid IMT, alteration of the dipping phenomenon, increased total and LDL-cholesterol, and increased C reactive protein, all related to the degree of cognitive dysfunction.
Collapse
Affiliation(s)
| | | | - Octavia Rusu
- Emergency University Hospital, Bucharest, Romania
| | | | | | | |
Collapse
|
10
|
Qin X, Zhang Q, Yang S, Sun Z, Chen X, Huang H. Blood Pressure Variability and Morning Blood Pressure Surge in Elderly Chinese Hypertensive Patients. J Clin Hypertens (Greenwich) 2014; 16:511-7. [PMID: 24775732 DOI: 10.1111/jch.12333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 04/02/2014] [Accepted: 04/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Xiaobo Qin
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Qin Zhang
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Suping Yang
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Zhongbo Sun
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Xiaojie Chen
- Department of Electrocardiography; The People's Hospital of Guangxi Zhuang Autonomous Region; Nanning China
| | - Huiling Huang
- Department of Cardiovascular Medicine; Affiliated First Hospital of Sun Yat-sun University; Guangzhou China
| |
Collapse
|