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Lee JJ, Lee KH. Optimal Systolic Blood Pressure for the Prevention of All-Cause and Cardiovascular Disease Mortality in Older Adults With Hypertension: Nationwide Population-Based Cohort Study. JMIR Public Health Surveill 2024; 10:e52182. [PMID: 38861307 PMCID: PMC11200037 DOI: 10.2196/52182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/21/2024] [Accepted: 05/05/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Target systolic blood pressure (SBP) levels for older adults with hypertension vary across countries, leading to challenges in determining the appropriate SBP level. OBJECTIVE This study aims to identify the optimal SBP level for minimizing all-cause and cardiovascular disease (CVD) mortality in older Korean adults with hypertension. METHODS This retrospective cohort study used data from the National Health Insurance Service database. We included older adults aged 65 years or older who were newly diagnosed with hypertension and underwent a National Health Insurance Service health checkup in 2003-2004. We excluded patients who had a history of hypertension or CVD, were not prescribed medication for hypertension, had missing blood pressure or any other covariate values, and had fewer than 2 health checkups during the follow-up period until 2020. We categorized the average SBP levels into 6 categories in 10 mm Hg increments, from <120 mm Hg to ≥160 mm Hg; 130-139 mm Hg was the reference range. Cox proportional hazards models were used to examine the relationship between SBP and all-cause and CVD mortalities, and subgroup analysis was conducted by age group (65-74 years and 75 years or older). RESULTS A total of 68,901 older adults newly diagnosed with hypertension were included in this study. During the follow-up period, 32,588 (47.3%) participants had all-cause mortality and 4273 (6.2%) had CVD mortality. Compared to older adults with SBP within the range of 130-139 mm Hg, individuals who fell into the other SBP categories, excluding those with SBP 120-129 mm Hg, showed significantly higher all-cause and CVD mortality. Subgroup analysis showed that older adults aged 65-74 years had higher all-cause and CVD mortality rates according to SBP categories than those aged 75 years or older. CONCLUSIONS The SBP levels within the range of 120-139 mm Hg were associated with the lowest all-cause and CVD mortality rates among older Korean adults with hypertension. It is recommended to reduce SBP to <140 mm Hg, with 120 mm Hg as the minimum value for SBP, for older Korean adults with hypertension. Additionally, stricter SBP management is required for adults aged 65-74 years.
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Affiliation(s)
- Jae Jun Lee
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
| | - Kyung Hee Lee
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, Seoul, Republic of Korea
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Beard J, Katja H, Si Y, Thiyagarajan J, Moreno-Agostino D. Is 70 the new 60? A longitudinal analysis of cohort trends inintrinsic capacity in England and China. RESEARCH SQUARE 2024:rs.3.rs-4271576. [PMID: 38853854 PMCID: PMC11160896 DOI: 10.21203/rs.3.rs-4271576/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
To understand how the health of older adults today compares to that of previous generations, we estimated intrinsic capacity and subdomains of cognitive, locomotor, sensory, psychological and vitality capacities in participants of the English Longitudinal Study on Ageing (ELSA) and the China Health and Retirement Longitudinal Study (CHARLS). We applied multilevel growth curve models to examine change over time and cohort trends. We found that more recent cohorts entered older ages with higher levels of capacity, and their subsequent age-related declines were somewhat compressed compared to earlier cohorts. These improvements in capacity were large, with the greatest gains being in the most recent cohorts. For example, a 68-year-old ELSA participant born in 1950 had higher capacity than a 62-year-old born just 10 years earlier. Trends were similar for men and women, and findings were generally consistent across English and Chinese cohorts.
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Affiliation(s)
- John Beard
- Columbia University - Mailman School of Public Health
| | | | - Yafei Si
- The University of New South Wales
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Mwangi M, Molenberghs G, Njagi EN, Mwalili S, Braekers R, Florez AJ, Gachau S, Bukania ZN, Verbeke G. Pairwise fitting of piecewise mixed models for the joint modeling of multivariate longitudinal outcomes, in a randomized crossover trial. Biom J 2024; 66:e2200333. [PMID: 38499515 DOI: 10.1002/bimj.202200333] [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: 11/30/2022] [Revised: 09/25/2023] [Accepted: 11/11/2023] [Indexed: 03/20/2024]
Abstract
Many statistical models have been proposed in the literature for the analysis of longitudinal data. One may propose to model two or more correlated longitudinal processes simultaneously, with a goal of understanding their association over time. Joint modeling is then required to carefully study the association structure among the outcomes as well as drawing joint inferences about the different outcomes. In this study, we sought to model the associations among six nutrition outcomes while circumventing the computational challenge posed by their clustered and high-dimensional nature. We analyzed data from a 2 × $\times$ 2 randomized crossover trial conducted in Kenya, to compare the effect of high-dose and low-dose iodine in household salt on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in women of reproductive age and their household matching pair of school-aged children. Two additional outcomes, namely, urinary iodine concentration (UIC) in women and children were measured repeatedly to monitor the amount of iodine excreted through urine. We extended the model proposed by Mwangi et al. (2021, Communications in Statistics: Case Studies, Data Analysis and Applications, 7(3), 413-431) allowing flexible piecewise joint models for six outcomes to depend on separate random effects, which are themselves correlated. This entailed fitting 15 bivariate general linear mixed models and deriving inference for the joint model using pseudo-likelihood theory. We analyzed the outcomes separately and jointly using piecewise linear mixed-effects (PLME) model and further validated the results using current state-of-the-art Jones and Kenward methodology (JKME model) used for analyzing randomized crossover trials. The results indicate that high-dose iodine in salt significantly reduced blood pressure (BP) compared to low-dose iodine in salt. Estimates for the random effects and residual error components showed that SBP and DBP had strong positive correlation, with effect of the random slope indicating that significantly related outcomes are strongly associated in their evolution. There was a moderately strong inverse relationship between evolutions of UIC and BP both in women and children. These findings confirmed the original hypothesis that high-dose iodine salt has significant lowering effect on BP. We further sought to evaluate the performance of our proposed PLME model against the widely used JKME model, within the multivariate joint modeling framework through a simulation study mimicking a2 × 2 $2\times 2$ crossover design. From our findings, the multivariate joint PLME model performed exceptionally well both in estimation of random-effects matrix (G) and Hessian matrix (H), allowing satisfactory model convergence during estimation. It allowed a more complex fit to the data with both random intercepts and slopes effects compared to the multivariate joint JKME model that allowed for random intercepts only. When a hierarchical viewpoint is adopted, in the sense that outcomes are specified conditionally upon random effects, the variance-covariance matrix of the random effects must be positive definite. In some cases, additional random effects could explain much variability in the data, thus improving precision in estimation of the estimands (effect size) parameters. The key highlight in this evaluation shows that multivariate joint JKME model is a powerful tool especially while fitting mixed models with random intercepts only, in crossover design settings. Addition of random slopes may lead to model complexities in most cases, resulting in unsatisfactory model convergence during estimation. To circumvent convergence pitfalls, extention of JKME model to PLME model allows a more flexible fit to the data (generated from crossover design settings), especially in the multivariate joint modeling framework.
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Affiliation(s)
- Moses Mwangi
- I-BioStat, Universiteit Hasselt, Diepenbeek, Belgium
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Geert Molenberghs
- I-BioStat, Universiteit Hasselt, Diepenbeek, Belgium
- L-BioStat, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Edmund Njeru Njagi
- Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Samuel Mwalili
- Statistics and Actuarial Sciences, Jomo Kenyatta University of Agriculture & Technology, Nairobi, Kenya
| | - Roel Braekers
- I-BioStat, Universiteit Hasselt, Diepenbeek, Belgium
| | - Alvaro Jose Florez
- School of Statistics, Universidad del Valle, Cali, Colombia
- Data Science Institute, I-BioStat, Universiteit Hasselt, Diepenbeek, Belgium
| | - Susan Gachau
- Center for Disease Control and Prevention, Nairobi, Kenya
| | - Zipporah N Bukania
- Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Geert Verbeke
- I-BioStat, Universiteit Hasselt, Diepenbeek, Belgium
- L-BioStat, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
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Pang J, Qian L, Che X, Lv P, Xu Q. TyG index is a predictor of all-cause mortality during the long-term follow-up in middle-aged and elderly with hypertension. Clin Exp Hypertens 2023; 45:2272581. [PMID: 37902269 DOI: 10.1080/10641963.2023.2272581] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/14/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The triglyceride and glucose (TyG) index has been found to be significantly associated with a higher risk of mortality. However, there has been a lack of studies exploring the specific relationship between the TyG index and all-cause and cardiovascular mortality among middle-aged and elderly with hypertension. METHODS A total of 3,614 participants with hypertension were enrolled from the National Health and Nutrition Examination Survey. The TyG index was calculated using the formula log [fasting triglycerides (mg/dL) x fasting glucose (mg/dL)/2]. The Cox proportional hazard ratios were used to evaluate the association between the TyG index and the risk of mortality. RESULTS Over a follow-up period of 7.87 years, 991 all-cause death and 189 cardiovascular deaths occurred. Compared with the reference quartile, the multivariate-adjusted hazard ratios and 95% confidence intervals were 1.28 (1.07-1.53; p = .006) in the fourth quartile for all-cause mortality and 0.63 (0.42-0.96; p = .031) in the second quartile for cardiovascular mortality. Dose-response analysis indicated an L-shaped relationship. CONCLUSIONS The TyG index exhibited an L-shaped association with the risk of all-cause mortality among middle-aged and elderly with hypertension.
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Affiliation(s)
- Jie Pang
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincical People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Linyan Qian
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincical People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiaoru Che
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincical People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Ping Lv
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincical People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Qiang Xu
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincical People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Abadía Cascajero MÁ, Alonso Safont T, Martín Fernández J. Impacto del control de la tensión arterial sobre la morbimortalidad en pacientes hipertensos mayores de 65 años en el ámbito comunitario. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2023. [DOI: 10.55783/rcmf.160104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
Objetivo: evaluar el impacto del control de la tensión arterial (TA) sobre la morbimortalidad en > 65 años, sin patología cardiovascular previa, en el ámbito comunitario.
Métodos: estudio de cohortes retrospectivas. Se incluyeron todos los pacientes (≥ 65 años) con diagnóstico de hipertensión arterial (HTA) (01/01/2007-31/12/2008), sin eventos cardiovasculares previos de los centros de salud de la Comunidad de Madrid, con al menos dos registros de TA el primer año de seguimiento (n = 17.150). Se evaluaron la aparición de eventos cardiovasculares (incluida mortalidad cardiovascular) y la mortalidad total, mediante regresión de Cox.
Resultados: la mediana de seguimiento para mortalidad fue de 90,48 meses (rango intercuartil [RIC]: 53,19-130,30 meses). Se produjeron 8.641 eventos cardiovasculares y 1.026 muertes por cualquier causa. Ajustado por género, grado de hipertensión, tabaquismo, diabetes e hipercolesterolemia, el buen control (TA < 140/90 mmHg) no se asociaba con una disminución de eventos cardiovasculares, pero sí con una disminución de mortalidad del 14,41% (hazard ratio [HR] 0,8559; intervalo de confianza [IC] 95%: 0,7776-0,9421%) entre 75 y 84 años. Cuando se utilizan las cifras de 130/80 mmHg para definir el buen control, este se asociaba con un exceso de mortalidad del 43,58% (IC 95%: 19,60-72,36%) entre 65 y 74 años y del 61,22% (IC 95%: 22,99-111,35%) en sujetos de 85 y más años.
Conclusión: el control de la TA en sujetos >65 años se asocia con una disminución ligera de la mortalidad entre 75 y 84 años. Cifras de control más estrictas se relacionan con mayor ocurrencia de evento cardiovascular y de mortalidad, especialmente en el grupo de mayor edad.
Palabras clave: hipertensión, indicadores de morbimortalidad, Atención Primaria de Salud, salud de la persona anciana.
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Affiliation(s)
- Marta Ángela Abadía Cascajero
- Departamento de Especialidades Médicas y Salud Pública. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Madrid. España
| | - Tamara Alonso Safont
- Dirección Técnica de Sistemas de Información. Gerencia Asistencial de Atención Primaria. Servicio Madrileño de Salud. Madrid. España.Doctoranda. Programa de Ciencias de la Salud, Universidad Rey Juan Carlos. Madrid. España
| | - Jesús Martín Fernández
- Departamento de Especialidades Médicas y Salud Pública. Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos. Madrid. España
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Asikainen A, Korja M, Kaprio J, Rautalin I. Case Fatality in Patients With Aneurysmal Subarachnoid Hemorrhage in Finland: A Nationwide Register-Based Study. Neurology 2023; 100:e348-e356. [PMID: 36257709 DOI: 10.1212/wnl.0000000000201402] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Although single-center studies have reported declining case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (SAH), nationwide reports that also include sudden-death SAHs with long uninterrupted study periods have remained limited. Moreover, little is known about whether the time-dependent trends of SAH CFR differ by age and/or sex. Thus, we aimed to characterize the nationwide changes of SAH CFRs in Finland between 1998 and 2017. METHODS We used 2 externally validated nationwide registers to identify all hospitalized and nonhospitalized (sudden-death) aneurysmal SAH events in Finland during 1998-2017. In addition to overall 30-day CFRs, we determined annual proportions of sudden-death and 30-day CFRs among hospitalized patients with SAH. To estimate time-dependent trends, we calculated annual age-adjusted and sex-adjusted CFR changes (percent with 95% CIs). RESULTS Between 1998 and 2017, we identified 9,443 cases with SAH (57.6% women), of which 2,245 (23.8%) died before hospitalization and 3,715 (39.3%) died within 30 days after SAH. Among the 7,198 hospitalized patients with SAH, the 30-day CFR was 20.4%. During the study period, the overall age-adjusted and sex-adjusted CFR declined by an average of 1.8% (1.1%-2.6%) per year. The decreases were especially notable in the proportion of sudden deaths among middle-aged (aged 40-64 years) and older (aged 65 years or older) women (2.9% [1.1%-4.7%] and 2.3% [0.7%-4.0%] per year, respectively) and in the CFRs of hospitalized young (younger than 40 years) and middle-aged women (9.1% [2.3%-15.7%] and 4.3% [2.3%-6.5%] per year, respectively). On the contrary, the 30-day CFR of older (aged 65 years or older) hospitalized men increased by 3.5% (0.7%-6.3%) per year, while the proportions of older men who died before hospitalization remained unchanged. DISCUSSION The overall CFR of SAH seems to be decreasing, at least among women. The continued high CFR of hospitalized older men requires attention from clinicians and epidemiologists, especially if this trend is also common in other countries.
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Affiliation(s)
- Aleksanteri Asikainen
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital; Department of Public Health (A.A.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland.
| | - Miikka Korja
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital; Department of Public Health (A.A.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland
| | - Jaakko Kaprio
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital; Department of Public Health (A.A.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland
| | - Ilari Rautalin
- From the Department of Neurosurgery (A.A., M.K., I.R.), University of Helsinki and Helsinki University Hospital; Department of Public Health (A.A.), University of Helsinki; and Institute for Molecular Medicine FIMM (J.K.), University of Helsinki, Finland
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Abstract
OBJECTIVE Both low and high body mass index (BMI) have been associated with greater mortality in older adults. This study aimed to evaluate the trajectory of BMI in the final years of life. METHODS A population-based cohort study was conducted including community-dwelling adults in the English Longitudinal Study of Ageing between 1998 and 2012. BMI was evaluated in relation to age and years before death. Number of long-term conditions, cigarette smoking and socioeconomic position were evaluated as effect modifiers. RESULTS Data were analysed for 16 924 participants with 31 857 BMI records; mean age at study starts, 61.6 (SD 10.9) years; mean BMI, 27.5 (4.7) Kg/m2. There were 3686 participants (4794 BMI records) who died and 13 238 participants (27 063 BMI records) who were alive at last follow-up. Mean BMI increased with age to 60-69 years but then declined, but the age-related decline was more rapid in decedents. From 4 to 7 years before death or end of study, adjusted mean BMI was 0.87 (95% CI 0.50 to 1.24) Kg/m2 lower for male decedents than survivors and 1.02 (0.56 to 1.47) lower in women; and from 3 to 0 years before death, BMI was 1.39 (0.98 to 1.80) Kg/m2 lower in male decedents and 2.12 (1.60 to 2.64) lower in female decedents. Multiple long-term conditions and lower socioeconomic position were associated with higher peak BMI and greater BMI decline; current smoking was associated with lower BMI and greater BMI decline. CONCLUSIONS In community-dwelling older adults, mean BMI enters an accelerating decline from up to 8 years before death. Multiple long-term conditions, smoking and lower socioeconomic position are associated with BMI decline.
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Affiliation(s)
- Hari Pai
- School of Life Course and Population Sciences, King's College London, Faculty of Life Sciences and Medicine, London, London, UK
| | - Martin C Gulliford
- School of Life Course and Population Sciences, King's College London, Faculty of Life Sciences and Medicine, London, London, UK
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Sánchez-Martínez M, López-García E, Guallar-Castillón P, Ortolá R, García-Esquinas E, Cruz J, Gijón-Conde T, Rodríguez-Artalejo F, Townsend RR, Banegas JR. Home and ambulatory blood pressure levels below target range and clinical effort to detect this condition: a population-based study in older treated hypertensives. Age Ageing 2022; 51:6454232. [PMID: 35150580 DOI: 10.1093/ageing/afab236] [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: 08/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND With implementation of stricter blood pressure (BP) treatment targets, potential for excessive BP lowering becomes an important issue, especially in older patients. OBJECTIVES Assess the magnitude, indicators and detection effort of BP levels below-target-range (BTR-BP) recommended by the European hypertension guidelines in older treated hypertensive patients (130-139/70-79 mmHg). DESIGN Cross-sectional, retrospective study (Seniors-ENRICA-2 cohort). SETTING General population. SUBJECTS 1,329 treated hypertensive patients aged ≥65, assessed with three home casual BP measurements and 24-hour ambulatory BP monitoring (ABPM). METHODS Based on the European hypertension guidelines and the literature, BTR-BPs were defined as mean BP <130/70, <125/65, <130/70 and <110/55 mmHg, for casual BP, 24-hour BP, daytime BP and nighttime BP, respectively, and hypotension as <110/70, <105/65, <110/70 and <90/55 mmHg, respectively. RESULTS Participants' mean age was 72 ± 4.4 (50.3%, women). Based on casual BP, 7.2% of patients were in target range (130-139/70-79 mmHg), 44.3% in BTR-BP (<130/70) and 20.8% hypotensive (<110/70). Some 44.9, 54.9 and 22.0% of patients were in BTR-BP for 24-hour BP, daytime BP and nighttime BP, respectively, and 11.0, 21.1 and 5.6%, respectively, were hypotensive. The number of patients needed for ABPM to detect one case of 24-hour-, daytime-, and nighttime-BTR-BP was 3, 2 and 5, respectively, and 10, 5 and 18, respectively, for detecting one hypotensive case. Cardiovascular disease and female sex were associated with both BTR-BP and hypotension, and the number of antihypertensive drugs was only associated with hypotension. CONCLUSIONS BTR-BP levels were common in older treated patients at home and in everyday life, more frequent than many trials report, and daytime ABPM is highly size-efficient for detecting the low ambulatory BP conditions.
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Affiliation(s)
- Mercedes Sánchez-Martínez
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
- Department of Health Science, Universidad Católica Santa Teresa de Jesús de Ávila, Ávila, Spain
| | - Esther López-García
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Juan Cruz
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
| | - Teresa Gijón-Conde
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
- Centro de Salud Universitario Cerro del Aire, Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Raymond R Townsend
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - José R Banegas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPAZ and CIBERESP, Madrid, Spain
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Perera RS, Chen L, Ferreira ML, Arden NK, Radojčić MR, Kluzek S. Age- and sex-specific effects of obesity, metabolic syndrome and its components on back pain: The English Longitudinal Study of Ageing. Joint Bone Spine 2022; 89:105366. [DOI: 10.1016/j.jbspin.2022.105366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/25/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
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10
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Song MS, Choi YJ, Kim H, Nam MJ, Lee CW, Han K, Jung JH, Park YG, Kim DH, Park JH. Relationship between blood pressure levels and ischemic stroke, myocardial infarction, and mortality in very elderly patients taking antihypertensives: a nationwide population-based cohort study. BMC Geriatr 2021; 21:620. [PMID: 34727876 PMCID: PMC8561930 DOI: 10.1186/s12877-021-02570-7] [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: 03/01/2021] [Accepted: 10/19/2021] [Indexed: 11/11/2022] Open
Abstract
Background In the very elderly, “the lower the better” hypothesis has constantly been contradicted by randomized control trials and various cohort studies, but inconsistency in results led to unclear blood pressure treatment targets. This study aimed to assess the relationship between baseline blood pressure (BP) and ischemic stroke, myocardial infarction, and all-cause mortality in very elderly people treated for hypertension. Methods This large population-based retrospective cohort study was based on the national claims database of the Korean National Health Insurance System, which covers the entire Korean population. 374,250 participants aged ≥ 75 years taking antihypertensive agents were recruited, excluding patients with a history of previous ischemic stroke or myocardial infarction. Results Systolic BP (SBP) followed a J curve for ischemic stroke and a U curve for all-cause mortality, with nadir ranges of 120 to 129 mmHg and 140 to 149 mmHg, respectively. While increasing diastolic BP (DBP) generally resulted in higher HRs for ischemic stroke, HRs for myocardial infarction and all-cause mortality significantly increased only when DBP was ≥ 80 mmHg and ≥ 90 mmHg, respectively. The SBP/DBP combination analysis showed that even with SBP < 130 mmHg, higher DBP ≥ 90 mmHg had higher HRs for all three outcomes compared to the reference group (130 to 149 / < 80 mmHg). Conclusions There were no further benefits or even harm below certain BP levels for ischemic stroke, myocardial infarction, and all-cause mortality in very elderly hypertensive patients.
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Affiliation(s)
- Myung-Sun Song
- Department of Ophthalmology, College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yeon Joo Choi
- Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Gyeonggi-do, Ansan, Republic of Korea
| | - Hyunjin Kim
- Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Gyeonggi-do, Ansan, Republic of Korea
| | - Myung Ji Nam
- Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Gyeonggi-do, Ansan, Republic of Korea
| | - Chung-Woo Lee
- Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Gyeonggi-do, Ansan, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong-Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Do-Hoon Kim
- Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Gyeonggi-do, Ansan, Republic of Korea.
| | - Joo-Hyun Park
- Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, 123, Jeokgeum-ro, Danwon-gu, Gyeonggi-do, Ansan, Republic of Korea.
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11
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Gao H, Wang K, Ahmadizar F, Zhao W, Jiang Y, Zhang L, Yu L, Zhou F, Gu J, Zhuang J, Xia ZL. Changes in late-life systolic blood pressure and all-cause mortality among oldest-old people in China: the chinese longitudinal healthy longevity survey. BMC Geriatr 2021; 21:562. [PMID: 34663235 PMCID: PMC8522233 DOI: 10.1186/s12877-021-02492-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 09/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background Blood pressure targets for oldest-old people have been long debated due to the concern that more stringent targets are associated with increased mortality. We aimed to investigate the association between changes of late-life systolic blood pressure (SBP), mean SBP and SBP variability (SBPV), and all-cause mortality in oldest-old. Methods Based on the community-based Chinese Longitudinal Healthy Longevity Survey with follow-up conducted in the 3-year interval, we assembled a retrospective cohort of 6639 participants ≥ 80 years with available blood pressure measurements at baseline and second wave. The primary exposures were mean SBP and SBPV (defined as the annual difference in SBP divided by mean SBP) measured between baseline and second wave. The primary outcome was all-cause mortality assessed from the second wave. Results During 21443.1 person-years of follow-up, 4622 death was recorded. U-shaped associations of mortality with mean SBP and SBPV were identified; the value of 137 mmHg and 4.0 %/year conferred the minimum mortality risk, respectively. The associations of a larger SBPV with an increased mortality risk were observed for both rises and large falls in SBP. The hazard ratio was 1.11 (comparing lowest versus middle quintile; 95 % CI: 1.01, 1.22) with large falls in SBPV and 1.08 (comparing highest versus middle quintile; 95 % CI: 0.98, 1.18) with large rises in SBPV. Conclusions U-shaped associations between late-life SBP and SBPV and all-cause mortality were found. Our study suggests that a stable SBP level in the middle range is related to lower mortality risk in the oldest-old. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02492-4.
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Affiliation(s)
- Hui Gao
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Kan Wang
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Fariba Ahmadizar
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Wensui Zhao
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Yu Jiang
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Lei Zhang
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Li Yu
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Fangjia Zhou
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Jialing Gu
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China
| | - Jianlin Zhuang
- Changning Center for Disease Control and Prevention, 39 Yunwushan Road, P.O. Box1003, 200032, Shanghai, China.
| | - Zhao-Lin Xia
- School of Public Health, Fudan University, Shanghai, China
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12
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Koudelka M, Sovová E. COVID-19 Causing Hypotension in Frail Geriatric Hypertensive Patients? ACTA ACUST UNITED AC 2021; 57:medicina57060633. [PMID: 34207161 PMCID: PMC8235779 DOI: 10.3390/medicina57060633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 01/16/2023]
Abstract
Background: The association of coronavirus disease 2019 (COVID-19) with hypertension has been one of the frequently discussed topics in current studies since hypertension was identified as a risk factor for coronavirus disease. However, no studies seem to be focused on the BP (blood pressure) in patients with hypertension after COVID-19. Report: This report presents the cases of five frail geriatric patients (avg. age 78.3 (±6.4) years) with sarcopenia and controlled hypertension (office BP < 140 mmHg) who were diagnosed with SARS-CoV-2. Findings: Control ABPM performed after COVID-19 showed that these hypertensive patients were hypotensive and that the previously well-established therapy was suddenly too intensive for them. Conclusions: These findings suggest that BP control after COVID-19 is needed and that ABPM is, particularly in frail geriatric patients, by no means a luxury but a necessity.
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Affiliation(s)
- Marek Koudelka
- Department of Exercise Medicine and Cardiovascular Rehabilitation, Palacký University Olomouc and University Hospital Olomouc, 77520 Olomouc, Czech Republic;
- Department of Internal Medicine, FRANZISKUS SPITAL GmbH, Landstraßer Hauptstraße 4a, 1030 Vienna, Austria
- Correspondence: ; Tel.: +43-1-71126; Fax: +43-1-711269968
| | - Eliška Sovová
- Department of Exercise Medicine and Cardiovascular Rehabilitation, Palacký University Olomouc and University Hospital Olomouc, 77520 Olomouc, Czech Republic;
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13
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Akpa OM, Okekunle AP, Ovbiagele B, Sarfo FS, Akinyemi RO, Akpalu A, Wahab KW, Komolafe M, Obiako R, Owolabi LF, Ogbole G, Fawale B, Fakunle A, Asaleye CM, Akisanya CO, Hamisu DA, Ogunjimi L, Adeoye A, Ogah O, Lackland D, Uvere EO, Faniyan MM, Asowata OJ, Adeleye O, Aridegbe M, Olunuga T, Yahaya IS, Olaleye A, Calys-Tagoe B, Owolabi MO. Factors associated with hypertension among stroke-free indigenous Africans: Findings from the SIREN study. J Clin Hypertens (Greenwich) 2021; 23:773-784. [PMID: 33484599 PMCID: PMC8263562 DOI: 10.1111/jch.14183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/24/2020] [Accepted: 01/03/2021] [Indexed: 01/14/2023]
Abstract
Hypertension is one of the most important risk factors for stroke and cardiovascular diseases (CVD) globally. Understanding risk factors for hypertension among individuals with matching characteristics with stroke patients may inform primordial/primary prevention of hypertension and stroke among them. This study identified the risk factors for hypertension among community-dwelling stroke-free population in Ghana and Nigeria. Data for 4267 community-dwelling stroke-free controls subjects in the Stroke Investigative Research and Education Network (SIREN) study in Nigeria and Ghana were used. Participants were comprehensively assessed for sociodemographic, lifestyle and metabolic factors using standard methods. Hypertension was defined as a previous diagnosis by a health professional or use of an anti-hypertensive drug or mean systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Logistic regression analysis was used to estimate adjusted odds ratios (aOR) of hypertension and their 95% confidence intervals (CI) at p < .05. Overall, 56.7% of the participants were hypertensive with a higher proportion among respondents aged ≥60 years (53.0%). Factors including physical inactivity (aOR: 9.09; 95% CI: 4.03 to 20.53, p < .0001), diabetes (aOR: 2.70; CI: 1.91 to 3.82, p < .0001), being ≥60 years (aOR: 2.22; 95% CI: 1.78 to 2.77, p < .0001), and family history of CVD (aOR 2.02; CI: 1.59 to 2.56, p < .0001) were associated with increased aOR of hypertension. Lifestyle factors were associated with hypertension in the current population of community-dwelling stroke-free controls in west Africa. Community-oriented interventions to address sedentary lifestyles may benefit this population and reduce/prevent hypertension and stroke among them.
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Affiliation(s)
- Onoja M Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Akinkunmi P Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.,The Postgraduate College, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- School of Medicine, Weill Institute for Neurosciences, University of California, San-Francisco, CA, USA
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rufus O Akinyemi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria.,Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Albert Akpalu
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Kolawole W Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Lukman F Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Ibadan, Nigeria
| | - Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Adekunle Fakunle
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christianah M Asaleye
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | | | - Luqman Ogunjimi
- Department of Pharmacology and Therapeutics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Shagamu, Nigeria
| | - Abiodun Adeoye
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Okechukwu Ogah
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Dan Lackland
- Medical University of South Carolina, Charleston, SC, USA
| | - Ezinne O Uvere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Osahon J Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Mayowa Aridegbe
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Taiwo Olunuga
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Isah S Yahaya
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Adeniji Olaleye
- Department of Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Benedict Calys-Tagoe
- Department of Community Health, University of Ghana Medical School, Accra, Ghana
| | - Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria.,Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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14
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Loaiza-Betancur AF, Chulvi-Medrano I. Is Low-Intensity Isometric Handgrip Exercise an Efficient Alternative in Lifestyle Blood Pressure Management? A Systematic Review. Sports Health 2020; 12:470-477. [PMID: 32776866 DOI: 10.1177/1941738120943882] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
CONTEXT High blood pressure is one of the leading preventable causes of cardiovascular death worldwide. In this regard, several studies have shown interest in the benefits of isometric exercise on blood pressure regulation. OBJECTIVE To assess whether low-intensity isometric handgrip exercise (LI-IHE) is an effective strategy to lower blood pressure levels in prehypertensive and hypertensive patients. DATA SOURCE This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and registered with PROSPERO. Potentially eligible studies were identified after a systematic search conducted on 4 international databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), PEDro, and SPORTDiscus. STUDY SELECTION We included randomized controlled trials that comprised patients who received LI-IHE. STUDY DESIGN Systematic review with meta-analysis. LEVEL OF EVIDENCE Level 3. DATA EXTRACTION Data related to patient characteristics, exercise programs, risk-of-bias assessment, and outcomes of interest were systematically reviewed independently by 2 authors. RESULTS The following reductions (mean differences) were observed after LI-IHE: systolic blood pressure (SBP), (MD) = -5.43 mm Hg; (95% CI, -8.47 to -2.39; P = 0.0005); diastolic blood pressure (DBP), -2.41 mm Hg (95% CI, -4.33 to -0.48; P = 0.01); mean arterial pressure (MAP), -1.28 mm Hg (95% CI, -2.99 to 0.44; P = 0.14). CONCLUSION LI-IHE seems to lower SBP, DBP, and MAP values in prehypertensive and hypertensive adults. It appears that LI-IHE reduces, in greater magnitude, blood pressure levels in hypertensive patients, specifically in patients aged <45 years, those who are overweight, and those on medications. Nevertheless, substantial heterogeneity in the main results and in the analyses by subgroups generated uncertainty about the real reduction magnitude that LI-IHE can produce on blood pressure.
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Affiliation(s)
| | - Iván Chulvi-Medrano
- UIRFIDE (Sport Performance and Physical Fitness Research Group), Department of Physical and Sports Education, Faculty of Physical Activity and Sport Sciences, Valencia, Spain
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15
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5341] [Impact Index Per Article: 1068.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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16
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Abstract
Introduction: Hypertension is highly prevalent in the elderly and represents a major risk factor for cardiovascular complications such as coronary heart disease, stroke, and cognitive dysfunction. Areas covered: The recently published AHA/ACC and ESC/ESH guidelines for the management of hypertension in adult populations modified their approach towards hypertension in the elderly, particularly in those older than 85 years. The new concepts presented in these guidelines are discussed. They recommend a less conservative threshold and lower blood pressures targets; an emphasis on considering the biological rather than chronological age for patients >85 years, and the use of single-pill combinations to simplify treatment algorithms and increase long-term drug adherence. Expert opinion: Considering the high prevalence of hypertension in the elderly and the negative impact of untreated hypertension, early detection of hypertension in patients over 60 years old is crucial. The screening of hypertension should be reinforced in patient populations using out-of-office BP measurements. The author supports the latest ESC/ESH guidelines, which define a threshold at >140 mmHg for patients aged 65 to 79 years and >160 mmHg for those >85 years and propose a target BP of 130-140 mmHg, while considering patient frailty and the tolerability of the treatment.
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Affiliation(s)
- Michel Burnier
- Hypertension Research Foundation , Saint-Légier , Switzerland
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17
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Prevalence and related factors of office and home hypotension in older treated hypertensive patients. Aging Clin Exp Res 2019; 31:1011-1017. [PMID: 30276633 DOI: 10.1007/s40520-018-1045-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/24/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Older hypertensive adults under treatment are especially susceptible to hypotensive episodes, which entail an elevated risk. However, data on this subject are very scarce. AIM The purpose of this study was to determine the prevalence and predictors of office and home hypotension in older (≥ 65 years) treated hypertensive adults. METHODS Blood pressure (BP) was measured at the office and at home, using a validated oscillometric device. Office and home hypotension were defined as systolic BP (SBP) < 110 and/or diastolic BP (DBP) < 70 mmHg, and SBP < 105 and/or DBP < 65 mmHg, respectively. Masked hypotension was considered when office BP ≥ 110/70 and home BP < 105 and/or < 65 mmHg. We evaluated factors associated with hypotension both at the office and at home through multivariable models. RESULTS The prevalence of hypotension among the 302 patients included in the study was 29.8% at the office and 23.9% at home, whereas the prevalence of masked hypotension was 10.4%. Older age, lower body mass index and use of calcium channel blockers were associated with office hypotension, while older age, diabetes and ischemic heart disease were predictors for home hypotension. CONCLUSION Hypotension is frequent in older hypertensive adults under treatment. The presence of diabetes, ischemic heart disease and older age should alert for screening of hypotension at home to avoid overtreatment.
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18
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A Community-Based Intervention for Improving Medication Adherence for Elderly Patients with Hypertension in Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050721. [PMID: 30823383 PMCID: PMC6427311 DOI: 10.3390/ijerph16050721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 12/12/2022]
Abstract
The chronic disease management program, a community-based intervention including patient education, recall and remind service, and reduction of out-of-pocket payment, was implemented in 2005 in Korea to improve patients’ adherence for antihypertensive medications. This study aimed to assess the effect of a community-based hypertension intervention intended to enhance patient adherence to prescribed medications. This study applied a non-equivalent control group design using the Korean National Health Insurance Big Data. Hongcheon County has been continuously implementing the intervention program since 2012. This study involved a cohort of patients with hypertension aged >65 and <85 years, among residents who lived in the study area for five years (between 2010 and 2014). The final number of subjects was 2685 in both the intervention and control region. The indirect indicators were analyzed as patients’ adherence and level of continuous treatment using the difference-in-difference regression. The proportion of hypertensive patients who continuously received insurance benefits for >240 days in 2014 was 81.0% in the intervention region and 79.7% in the control region. The number of dispensations per prescription and the dispensation days per hypertensive patient in the intervention region increased by approximately 10.88% and 2.2 days on average by month, respectively, compared to those in the control region. The intervention program encouraged elderly patients with hypertension to receive continuous care. Another research is needed to determine whether further improvement in the continuity of comprehensive care will prevent the progression of cardiovascular diseases.
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19
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Palmiero P, Zito A, Maiello M, Cecere A, Mattioli AV, Pedrinelli R, Scicchitano P, Ciccone MM. Primary Prevention of Cardiovascular Risk in Octogenarians by Risk Factors Control. Curr Hypertens Rev 2019; 15:78-84. [PMID: 30747075 PMCID: PMC6635644 DOI: 10.2174/1573402115666190211160811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/19/2018] [Accepted: 02/01/2019] [Indexed: 01/03/2023]
Abstract
Primary prevention of cardiovascular events in older adults is a relevant problem, due to lack of evidence for safe and efficacious therapy, its costs and elderly quality of life, Italy's aging population is constantly increasing, so cardiovascular disease (CVD) primary prevention in the elderly is a prime objective. Life expectancy has dramatically increased over the last 2 decades, the proportion of individuals aged 80 years and older has grown rapidly in Europe and the United States, but cost / effective ratio of CVD prevention through risk factors control is debated. It is therefore important to implement cardiovascular risk factors estimation in the elderly to maximize the quality of life of patients and to lengthen their healthy life expectancy, choosing the better treatment for each patient sharing the choice with himself when it is possible, always remembering that elderly patients often have multiple co-morbidities that require a high number of concurrent medications; this may increase the risk for drug-drug interactions, thereby reducing the potential benefits of CVD prevention therapy. Nevertheless, CVD is not an inevitable concomitant of aging. Sometimes, autopsy in the elderly reveals atheroma-free coronary arteries, a normal-sized heart and unscarred valves. All primary prevention strategy decisions should consider estimated life expectancy and overall function and not just the cardiovascular event risks, magnitude and time to benefit or harm, potentially altered adverse effect profiles, and informed patient preferences. CVD primary prevention needs to be more implemented in the elderly, this might contribute to improve health status and quality of life in this growing population if correctly performed.
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Affiliation(s)
- Pasquale Palmiero
- Address correspondence to this author at the ASL BRINDISI, Cardiology Equipe, District of Brindisi, Via Dalmazia 3, 72100 Brindisi, Italy; E-mail:
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20
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4525] [Impact Index Per Article: 754.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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21
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Zhu H, Zhu L, Fang Z, Yang S, Chen Y, Jin Y, Zhao X, Shen C, Yao Y. Common variants at somatostatin are significantly associated with hypertension incidence in smoking and drinking populations. ACTA ACUST UNITED AC 2018; 12:230-237.e12. [PMID: 29426577 DOI: 10.1016/j.jash.2017.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 12/23/2022]
Abstract
Somatostatin (SST) and growth hormone-releasing hormone (GHRH) are involved in the development of hypertension. This study aimed to evaluate whether SST and GHRH contribute to genetic susceptibility to hypertension. A case-control study consisting of 2012 hypertensive patients and 2210 matched control individuals was performed, and three tagging single-nucleotide polymorphisms were genotyped. The association of these single-nucleotide polymorphisms with hypertension and ischemic stroke was further evaluated among 4098 participants in a follow-up study. Hazard ratio (HR) and 95% confidence interval were estimated by Cox proportional hazards regression. The follow-up study indicated that in smoking population, variants at SST presented significant association with hypertension incidence; the adjusted HR of rs3755792 (GA + AA vs. GG) was 0.634 (P = .037), and the adjusted HR of rs7624906 (TC + CC vs. TT) was 1.803 (P = .005). In drinking population, rs3755792 at SST was associated with hypertension incidence, and the adjusted HR was 0.580 (P = .009). Moreover, rs6032470 at GHRH had a statistical association with ischemic stroke incidence in smoking population, and the adjusted HR of the additive model was 1.625 (P = .049). These results suggested that SST and GHRH harbor genetic susceptible loci with incident hypertension and ischemic stroke and that smoking and drinking might modify the genetic effect.
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Affiliation(s)
- Hui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Wannan Medical College, Wuhu, China
| | - Lijun Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Wannan Medical College, Wuhu, China
| | - Zhengmei Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Wannan Medical College, Wuhu, China
| | - Song Yang
- Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
| | - Yanchun Chen
- Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
| | - Yuelong Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Wannan Medical College, Wuhu, China
| | - Xianghai Zhao
- Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, People's Hospital of Yixing City, Yixing, China
| | - Chong Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Yingshui Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Wannan Medical College, Wuhu, China.
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22
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Corrao G, Monzio Compagnoni M, Franchi M, Cantarutti A, Pugni P, Merlino L, Catapano AL, Mancia G. Good adherence to therapy with statins reduces the risk of adverse clinical outcomes even among very elderly. Evidence from an Italian real-life investigation. Eur J Intern Med 2018; 47:25-31. [PMID: 28958460 DOI: 10.1016/j.ejim.2017.09.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/31/2017] [Accepted: 09/21/2017] [Indexed: 12/17/2022]
Abstract
AIM To assess whether in individuals aged 80years or older adherence to statins is accompanied by a reduced risk of all-cause mortality and major cardiovascular events. METHODS A nested case-control study was carried out on a cohort of patients aged 80years or older (very elderly individuals), who were under treatment with statins between 2008 and 2009, using the database available for all citizenship (about 10 million) of Lombardy (Italy). Cases were the cohort members who experienced death or hospitalization for stroke, myocardial infarction or heart failure from the initial prescription until 2012. Up to five controls were randomly selected for each case. Logistic regression was used to model the outcome risk associated with the adherence to therapy with statins. Two younger patient cohorts aged 60 to 69years and 70 to 79years were taken for comparison. A set of sensitivity analyses was performed in order to account for sources of systematic uncertainty. RESULTS Among very elderly individuals, those who had high adherence to statins showed significant risk reductions of death (56%; 95% Confidence Interval, 54% to 59%), myocardial infarction (15%; 5% to 24%), stroke (13%; 0% to 24%) and heart failure (30%; 23% to 36%) with respect to those at very low adherence. Adherence-related risk reductions were only slightly better for younger cohort members. CONCLUSIONS Adherence to therapy with statins reduced the risk of both death and cardiovascular morbidity in patients aged 80years or older.
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Affiliation(s)
- Giovanni Corrao
- Interuniversity Centre of Healthcare Research & Pharmacoepidemiology, Laboratory of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
| | - Matteo Monzio Compagnoni
- Interuniversity Centre of Healthcare Research & Pharmacoepidemiology, Laboratory of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Matteo Franchi
- Interuniversity Centre of Healthcare Research & Pharmacoepidemiology, Laboratory of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Anna Cantarutti
- Interuniversity Centre of Healthcare Research & Pharmacoepidemiology, Laboratory of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Pietro Pugni
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Luca Merlino
- Operative Unit of Territorial Health Services, Lombardy Region, Milan, Italy
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, Centre of Epidemiology and Preventive Pharmacology (SEFAP), University of Milano, Milan, Italy; IRCSS Multimedica, Sesto San Giovanni, Milan, Italy
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23
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Declining blood pressure and intensification of blood pressure management among people over 80 years: cohort study using electronic health records. J Hypertens 2017; 35:1276-1282. [PMID: 28441696 PMCID: PMC5404403 DOI: 10.1097/hjh.0000000000001291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Management of high blood pressure (BP) in people over 80 years is controversial, but there is limited information available concerning the uptake of hypertension treatment at this age. Objective: To evaluate use of antihypertensive drugs and changes in SBP and DBP from 2001 to 2014 in men and women aged 80 years and over. Methods: Cohort study using primary care electronic health records of 265 225 participants from the UK Clinical Practice Research Datalink. Records of BP and antihypertensive medications were analysed. Linear trends were estimated by frailty category in multiple regression models. Results: Data were analysed for 116 401 men and 148 824 women. The proportion with BP recorded increased from 51% in 2001 to 78% in 2014. The proportion of patients prescribed antihypertensive medications increased from 64 to 76%. Mean SBP declined from 150 (SD 20) mmHg in 2001 to 135 (16) mmHg in 2014. In ‘fit’ participants, the decline in SBP was 12.4 (95% confidence interval 11.9–13.0) mmHg/decade in those treated for hypertension and 8.5 (7.8–9.1) mmHg in those not treated. The decline in SBP was smaller as frailty increased. The proportion of all participants with BP less than 140/90 mmHg increased from 14 to 44% in the study period. Conclusion: In octogenarians, BP treatment has intensified between 2001 and 2014. BP values have declined in both treated and untreated participants, with a substantial increase in the proportion achieving conventional BP targets.
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24
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Affiliation(s)
- Anna F Dominiczak
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.F.D); and American Heart Association, Dallas, TX (D.K.).
| | - Denise Kuo
- From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.F.D); and American Heart Association, Dallas, TX (D.K.)
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25
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Zheng R, Mao Y. Triglyceride and glucose (TyG) index as a predictor of incident hypertension: a 9-year longitudinal population-based study. Lipids Health Dis 2017; 16:175. [PMID: 28903774 PMCID: PMC5598027 DOI: 10.1186/s12944-017-0562-y] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/04/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hypertension and the triglyceride and glucose index both have been associated with insulin resistance; however, the longitudinal association remains unclear. This study was designed to investigate the longitudinal association between the triglyceride and glucose index and incident hypertension among the Chinese population. METHODS We studied 4686 subjects (3177 males and 1509 females) and followed up for 9 years. The subjects were divided into four groups based on the triglyceride and glucose index. Univariate and multivariate Cox regression models were used to analyse the risk factors of hypertension. RESULTS After 9 years of follow-up, 2047 subjects developed hypertension. The overall 9-year cumulative incidence of hypertension was 43.7%, ranging from 28.5% in quartile 1 to 36.9% in quartile 2, 49.2% in quartile 3 and 59.8% in quartile 4 (p for trend < 0.001). Cox regression analyses indicated that higher triglyceride and glucose index was associated with an increased risk of subsequent incident hypertension. CONCLUSION The triglyceride and glucose index can predict the incident hypertension among the Chinese population.
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Affiliation(s)
- Rongjiong Zheng
- Department of Endocrinology, the Affiliated Hospital of Ningbo University School of Medicine, 247 Renmin Road, Ningbo, 315020, China. .,Ningbo University, Ningbo, China.
| | - Yushan Mao
- Department of Endocrinology, the Affiliated Hospital of Ningbo University School of Medicine, 247 Renmin Road, Ningbo, 315020, China. .,Ningbo University, Ningbo, China.
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26
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Hazra NC, Gulliford M. Evolution of the "fourth stage" of epidemiologic transition in people aged 80 years and over: population-based cohort study using electronic health records. Popul Health Metr 2017; 15:18. [PMID: 28499387 PMCID: PMC5429583 DOI: 10.1186/s12963-017-0136-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/04/2017] [Indexed: 01/15/2023] Open
Abstract
Background In the “fourth stage” of epidemiological transition, the distribution of non-communicable diseases is expected to shift to more advanced ages, but age-specific changes beyond 80 years of age have not been reported. Methods This study aimed to evaluate demographic and health transitions in a population aged 80 years and over in the United Kingdom from 1990 to 2014, using primary care electronic health records. Epidemiological analysis of chronic morbidities and age-related impairments included a cohort of 299,495 participants, with stratified sampling by five-year age group up to 100 years and over. Cause-specific proportional hazards models were used to estimate hazard ratios for incidence rates over time. Results Between 1990 and 2014, nonagenarians and centenarians increased as a proportion of the over-80 population, as did the male-to-female ratio among individuals aged 80 to 95 years. A lower risk of coronary heart disease (HR 0.54, 95% confidence interval [CI]: 0.50–0.58), stroke (0.83, 0.76–0.90) and chronic obstructive pulmonary disease (0.59, 0.54–0.64) was observed among 80–84 year-olds in 2010–2014 compared to 1995–1999. By contrast, the risk of type II diabetes (2.18, 1.96–2.42), cancer (1.52, 1.43–1.61), dementia (2.94, 2.70–3.21), cognitive impairment (5.57, 5.01–6.20), and musculoskeletal pain (1.26, 1.21–1.32) was greater in 2010–2014 compared to 1995–1999. Conclusions Redistribution of the over-80 population to older ages, and declining age-specific incidence of cardiovascular and respiratory diseases in over-80s, are consistent with the “fourth stage” of epidemiologic transition, but increases in diabetes, cancer, and age-related impairment show new emerging epidemiological patterns in the senior elderly. Electronic supplementary material The online version of this article (doi:10.1186/s12963-017-0136-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nisha C Hazra
- Department of Primary Care and Public Health Sciences, King's College London, 3rd Floor Addison House, Guy's Campus, London, SE1 1UL, UK.
| | - Martin Gulliford
- Department of Primary Care and Public Health Sciences, King's College London, 3rd Floor Addison House, Guy's Campus, London, SE1 1UL, UK.,NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
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27
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Divisón-Garrote JA, Ruilope LM, de la Sierra A, de la Cruz JJ, Vinyoles E, Gorostidi M, Escobar-Cervantes C, Velilla-Zancada SM, Segura J, Banegas JR. Magnitude of Hypotension Based on Office and Ambulatory Blood Pressure Monitoring: Results From a Cohort of 5066 Treated Hypertensive Patients Aged 80 Years and Older. J Am Med Dir Assoc 2017; 18:452.e1-452.e6. [DOI: 10.1016/j.jamda.2017.01.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 01/30/2023]
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28
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Ravindrarajah R, Hazra NC, Hamada S, Charlton J, Jackson SHD, Dregan A, Gulliford MC. Systolic Blood Pressure Trajectory, Frailty, and All-Cause Mortality >80 Years of Age: Cohort Study Using Electronic Health Records. Circulation 2017; 135:2357-2368. [PMID: 28432148 DOI: 10.1161/circulationaha.116.026687] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials show benefit from lowering systolic blood pressure (SBP) in people ≥80 years of age, but nonrandomized epidemiological studies suggest lower SBP may be associated with higher mortality. This study aimed to evaluate associations of SBP with all-cause mortality by frailty category >80 years of age and to evaluate SBP trajectories before death. METHODS A population-based cohort study was conducted using electronic health records of 144 403 participants ≥80 years of age registered with family practices in the United Kingdom from 2001 to 2014. Participants were followed for ≤5 years. Clinical records of SBP were analyzed. Frailty status was classified using the e-Frailty Index into the categories of fit, mild, moderate, and severe. All-cause mortality was evaluated by frailty status and mean SBP in Cox proportional-hazards models. SBP trajectories were evaluated using person months as observations, with mean SBP and antihypertensive treatment status estimated for each person month. Fractional polynomial models were used to estimate SBP trajectories over 5 years before death. RESULTS During follow-up, 51 808 deaths occurred. Mortality rates increased with frailty level and were greatest at SBP <110 mm Hg. In fit women, mortality was 7.7 per 100 person years at SBP 120 to 139 mm Hg, 15.2 at SBP 110 to 119 mm Hg, and 22.7 at SBP <110 mm Hg. For women with severe frailty, rates were 16.8, 25.2, and 39.6, respectively. SBP trajectories showed an accelerated decline in the last 2 years of life. The relative odds of SBP <120 mm Hg were higher in the last 3 months of life than 5 years previously in both treated (odds ratio, 6.06; 95% confidence interval, 5.40-6.81) and untreated (odds ratio, 6.31; 95% confidence interval, 5.30-7.52) patients. There was no evidence of intensification of antihypertensive therapy in the final 2 years of life. CONCLUSIONS A terminal decline of SBP in the final 2 years of life suggests that nonrandomized epidemiological associations of low SBP with higher mortality may be accounted for by reverse causation if participants with lower blood pressure values are closer, on average, to the end of life.
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Affiliation(s)
- Rathi Ravindrarajah
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.).
| | - Nisha C Hazra
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Shota Hamada
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Judith Charlton
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Stephen H D Jackson
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Alex Dregan
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
| | - Martin C Gulliford
- From Department of Primary Care and Public Health Sciences (R.R., N.C.H., S.H., J.C., A.D., M.C.G.), Department of Clinical Gerontology (J.C., S.H.D.J.), King's College London, UK; Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan (S.H.); and National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, London, UK (A.D., M.C.G.)
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