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Pan PJ, Lee CH, Hsu NW, Sun TL. Combining principal component analysis and logistic regression for multifactorial fall risk prediction among community-dwelling older adults. Geriatr Nurs 2024; 57:208-216. [PMID: 38696878 DOI: 10.1016/j.gerinurse.2024.04.021] [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: 01/08/2024] [Revised: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 05/04/2024]
Abstract
Falls require comprehensive assessment in older adults due to their diverse risk factors. This study aimed to develop an effective fall risk prediction model for community-dwelling older adults by integrating principal component analysis (PCA) with machine learning. Data were collected for 45 fall-related variables from 1630 older adults in Taiwan, and models were developed using PCA and logistic regression. The optimal model, PCA with stepwise logistic regression, had an area under the receiver operating characteristic curve of 0.78, sensitivity of 74 %, specificity of 70 %, and accuracy of 71 %. While dimensionality reduction via PCA is not essential, it aids practicality. Our framework combines PCA and logistic regression, providing a reliable method for fall risk prediction to support consistent screening and targeted health promotion. The key innovation is using PCA prior to logistic regression, overcoming conventional limitations. This offers an effective community-based fall screening tool for older adults.
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Affiliation(s)
- Po-Jung Pan
- Department of Physical Medicine & Rehabilitation, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; Center of Community Medicine, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Hsuan Lee
- Department of Data Science, Soochow University, Taipei, Taiwan.
| | - Nai-Wei Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Public Health Bureau, Yilan County, Taiwan; Community Medicine Research Center & Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tien-Lung Sun
- Department of Industrial Engineering and Management, Yuan-Ze University, Taoyuan, Taiwan
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Röthlisberger D, Jungo KT, Bütikofer L, Poortvliet RKE, Gussekloo J, Streit S. Association of low blood pressure and falls: An analysis of data from the Leiden 85-plus Study. PLoS One 2023; 18:e0295976. [PMID: 38117755 PMCID: PMC10732458 DOI: 10.1371/journal.pone.0295976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/28/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Falls and consequent injuries are prevalent in older adults. In this group, half of injury-related hospitalizations are associated with falls and the rate of falls increases with age. The evidence on the role of blood pressure and the use of antihypertensive treatment on the risk of falls remains unclear in oldest-old adults (≥85 years). OBJECTIVES To examine the association between systolic blood pressure (SBP) and incident falls with medical consequences in oldest-old adults and to analyse whether this association is modified by the use of antihypertensive treatments or the presence of cardiovascular disease. METHODS We analysed data from the Leiden 85-plus Study, a prospective, population-based cohort study with adults aged ≥85 years and a 5-year follow-up. Falls with medical consequences were reported by the treating physician of participants. We assessed the association between time-updated systolic blood pressure and the risk of falling over a follow-up period of five years using generalized linear mixed effects models with a binomial distribution and a logit link function. Subgroup analyses were performed to examine the role of antihypertensive treatment and the difference between participant with and without cardiovascular disease. RESULTS We analysed data from 544 oldest-old adults, 242 (44.4%) of which used antihypertensives. In 81 individuals (15%) ≥1 fall(s) were reported during the follow-up period. The odds for a fall decreased by a factor of 0.86 (95% CI 0.80 to 0.93) for each increase in blood pressure by 10 mmHg. This effect was specific to blood pressure values above 130mmHg. We did not find any evidence that the effect would be modified by antihypertensive treatment, but that there was a tendency that it would be weaker in participants with cardiovascular disease (OR 0.81, 95% CI 0.72 to 0.90 per 10mmHg) compared to those without cardiovascular disease (OR 0.94, 95% CI 0.84 to 1.05 per 10mmHg). CONCLUSION Our results point towards a possible benefit of higher blood pressure in the oldest-old with respect to falls independent of the use of antihypertensive treatments.
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Affiliation(s)
- David Röthlisberger
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | | | | | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Fall Risk in Adult Family Practice Non-Attenders: A Cross-Sectional Study from Slovenia. Zdr Varst 2023. [DOI: 10.2478/sjph-2023-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
ABSTRACT
Introduction
Not much is known about the fall risk among the adult population of those who rarely visit doctors. We wanted to determine the prevalence of increased fall risk in a population of family practice non-attenders and the factors associated with it.
Methods
We included participants from family medicine practices in this cross-sectional study. To be included in the study, the participants had to be adults living in the community (home-dwelling people) who had not visited their chosen family physician in the last five years (non-attenders). The identification of the eligible persons was done through a search of electronic medical records, which yield 2,025 non-attenders. Community nurses collected data in the participants’ homes. The outcome measure was increased fall risk as assessed by the Morse fall scale: increased risk (≥25) vs. no risk.
Results
The sample consisted of 1,945 patients (96.0% response rate) with a mean age of 60.4 years (range 20.5 to 99.7 years). An increased fall risk was determined in 482 or 24.8% (95% CI: [22.9, 26.8]) of the patients. The multivariate model showed a significant association of increased fall risk with higher age (p<0.001), lower systolic blood pressure (p=0.047), poor family function (p=0.016), increased risk of malnutrition (p=0.013), higher number of chronic diseases (p=0.027), higher pain intensity (p<0.001), lower self-assessment of current health (p=0.002), and higher dependence in daily activities (p<0.001).
Conclusion
Non-attenders may have an increased risk of falling which depends on their health status and age. The inclusion of community nurses in primary healthcare teams could be of use not only to identify the non-attenders’ health needs, but also to better manage their health, especially the factors that were identified to be associated with greater fall risk.
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Huang X, Zhang T, Guo P, Gong W, Zhu H, Zhao M, Yuan Z. Association of antihypertensive drugs with fracture and bone mineral density: A comprehensive drug-target Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1164387. [PMID: 37056679 PMCID: PMC10086430 DOI: 10.3389/fendo.2023.1164387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Background Observational studies have investigated the associations between antihypertensive drugs and fracture risk as well as bone mineral density (BMD), but yielding controversial results. Methods In this study, a comprehensive drug-target Mendelian randomization (MR) analysis was conducted to systematically examine the associations between genetic proxies for eight common antihypertensive drugs and three bone health-related traits (fracture, total body BMD [TB-BMD], and estimated heel BMD [eBMD]). The main analysis used the inverse-variance weighted (IVW) method to estimate the causal effect. Multiple MR methods were also employed to test the robustness of the results. Results The genetic proxies for angiotensin receptor blockers (ARBs) were associated with a reduced risk of fracture (odds ratio [OR] = 0.67, 95% confidence interval [CI]: 0.54 to 0.84; P = 4.42 × 10-4; P-adjusted = 0.004), higher TB-BMD (β = 0.36, 95% CI: 0.11 to 0.61; P = 0.005; P-adjusted = 0.022), and higher eBMD (β = 0.30, 95% CI: 0.21 to 0.38; P = 3.59 × 10-12; P-adjusted = 6.55 × 10-11). Meanwhile, genetic proxies for calcium channel blockers (CCBs) were associated with an increased risk of fracture (OR = 1.07, 95% CI: 1.03 to 1.12; P = 0.002; P-adjusted = 0.013). Genetic proxies for potassium sparing diuretics (PSDs) showed negative associations with TB-BMD (β = -0.61, 95% CI: -0.88 to -0.33; P = 1.55 × 10-5; P-adjusted = 1.86 × 10-4). Genetic proxies for thiazide diuretics had positive associations with eBMD (β = 0.11, 95% CI: 0.03 to 0.18; P = 0.006; P-adjusted = 0.022). No significant heterogeneity or pleiotropy was identified. The results were consistent across different MR methods. Conclusions These findings suggest that genetic proxies for ARBs and thiazide diuretics may have a protective effect on bone health, while genetic proxies for CCBs and PSDs may have a negative effect.
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Affiliation(s)
- Xin Huang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
| | - Tianxin Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
| | - Ping Guo
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
| | - Weiming Gong
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
| | - Hengchao Zhu
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, United States
| | - Meng Zhao
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhongshang Yuan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Institute for Medical Dataology, Shandong University, Jinan, Shandong, China
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Terapia farmacológica en la prevención secundaria del ictus isquémico en los muy ancianos: ¿ha mejorado en las últimas décadas? Rev Clin Esp 2023. [DOI: 10.1016/j.rce.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Castilla-Guerra L, Fernández-Moreno MC, González-Iglesias ML, Boceta-Osuna J, Gutiérrez-Gutiérrez B, Jiménez-Hernández MD. Pharmacological therapy in the secondary prevention of ischemic stroke in the oldest-old patients: has it improved in recent decades? Rev Clin Esp 2023; 223:202-208. [PMID: 36842658 DOI: 10.1016/j.rceng.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
INTRODUCTION Population aging has caused an increase in strokes in very elderly patients (VEP). We assess how secondary prevention of ischemic stroke has changed in VEP in recent decades. METHOD Retrospective study of discharges due to ischemic stroke in the Virgen Macarena, Virgen del Rocio and Valme hospitals in Seville (Spain), during the periods 1999-2001, 2014-16 and 2019-2020. VEP were considered those with ≥80 years. RESULT We studied 1806 patients, 349 (19.3%) were VEP. Over the years, VEPs have doubled (13.5% vs. 25.9% and 28% p = 0.0001) and age has increased (83.3 ± 3 vs. 84.1 ± 3 vs. 85.2 ± 4 p = 0.001). Comparing the periods, the VEPs have more hypertension (69.9% vs. 84.8% vs. 84.6%; p = 0.0001) and dyslipidemia (12% vs. 41.7% vs. 52.3%; p = 0.0001) and have prescribed more antihypertensives (69.1% vs. 86.7% vs. 92.3%; p = 0.0001), statins (5.3% vs. 78% vs. 81.5%; p = 0.0001) and anticoagulants (16.5% vs. 19.4% vs. 53.1%; p = 0.001), increasing the number of antihypertensives (1 ± 0.9 vs. 1.6 ± 0, 9 vs. 1.9 ± 0.8 drugs p = 0.0001), and high-intensity statins (2.3% vs. 42.7 vs. 69.2% p = 0.0001). Comparing the VEPs with the younger ones, there were no differences in antihypertensive treatment in any period, there were differences in antithrombotic treatment in the first period, and with statins the differences were maintained until the end. CONCLUSIONS In the last 20 years the number of VEPs has doubled, exceeding a quarter of the discharges. Although there is improvement in secondary stroke prevention in VEPs, there is room for improvement.
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Affiliation(s)
- L Castilla-Guerra
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain.
| | - M C Fernández-Moreno
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - M L González-Iglesias
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J Boceta-Osuna
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - B Gutiérrez-Gutiérrez
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - M D Jiménez-Hernández
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Yang JH, Jeong JA, Kweon SS, Shin MH. Association Between Regional Levels of Particulate Matter and Recurrent Falls in Korea. J Korean Med Sci 2023; 38:e19. [PMID: 36625175 PMCID: PMC9829513 DOI: 10.3346/jkms.2023.38.e19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/11/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND We investigated the extent of regional disparity of recurrent falls. In addition, we examined the association between particulate matter (PM) and recurrent falls and the association between regional disparity of recurrent falls and regional PM levels. METHOD We used data from Korea Community Health Survey 2019 that included 204,395 participants from 237 municipal districts. The independent variables were the annual average PM10 and PM2.5 concentrations measured at the air quality measuring stations in each municipal district. The outcome variable was the experience of falls more than twice in the previous year. Multilevel analyses were conducted to estimate the association between regional PM10 and PM2.5 levels and recurrent falls. RESULTS The regional variation was greater in the young people than that in the older people. PM10 and PM2.5 levels were positively associated with recurrent falls after adjusting for individual and regional covariates. These associations were more evident in the older group than in the young. PM10 and PM2.5 explained 2.82% and 3.33% of the remaining regional variance in models with individual and regional confounders, respectively. These proportions were greater in the older group (PM10 and PM2.5; 4.73% and 5.27%) than those in the younger age group (PM10 and PM2.5, 0.80% and 1.39%). CONCLUSION PM concentration was associated with recurrent falls even after accounting for other regional variables and individual-level differences. Moreover, there were regional differences in the occurrence of falls, and the PM concentration explained a part of the gap, but the gap was explained more in the older group than in the young.
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Affiliation(s)
- Jung-Ho Yang
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Ji-An Jeong
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Hwasun, Korea.
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Karayiannis CC. Hypertension in the older person: is age just a number? Intern Med J 2022; 52:1877-1883. [PMID: 36326489 PMCID: PMC9828098 DOI: 10.1111/imj.15949] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/25/2022] [Indexed: 11/06/2022]
Abstract
Older patients with hypertension are at a higher risk of cardiovascular events compared to younger adults but are also more vulnerable to the adverse effects of blood pressure (BP) lowering. Frailty is an important predictor of vulnerability to such adverse events, and age alone may not best reflect underlying risk. Therefore, an individualised approach to management of hypertension in the older person is required. Such an approach requires knowledge of frailty, the physiology of hypertension and ageing and a contextual understanding of best evidence. Management needs to be holistic and take account of the older person's care needs, wishes and priorities. This review describes physiological considerations and current guidelines and best practices regarding BP lowering in older people and highlights areas with paucity of evidence. A proposed and testable approach to managing hypertension in the older person (≥70 years) is discussed.
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Affiliation(s)
- Christopher C. Karayiannis
- Department of MedicinePeninsula HealthMelbourneVictoriaAustralia
- Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
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Mackenzie IS, Rogers A, Poulter NR, Williams B, Brown MJ, Webb DJ, Ford I, Rorie DA, Guthrie G, Grieve JWK, Pigazzani F, Rothwell PM, Young R, McConnachie A, Struthers AD, Lang CC, MacDonald TM. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 2022; 400:1417-1425. [PMID: 36240838 PMCID: PMC9631239 DOI: 10.1016/s0140-6736(22)01786-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Studies have suggested that evening dosing with antihypertensive therapy might have better outcomes than morning dosing. The Treatment in Morning versus Evening (TIME) study aimed to investigate whether evening dosing of usual antihypertensive medication improves major cardiovascular outcomes compared with morning dosing in patients with hypertension. METHODS The TIME study is a prospective, pragmatic, decentralised, parallel-group study in the UK, that recruited adults (aged ≥18 years) with hypertension and taking at least one antihypertensive medication. Eligible participants were randomly assigned (1:1), without restriction, stratification, or minimisation, to take all of their usual antihypertensive medications in either the morning (0600-1000 h) or in the evening (2000-0000 h). Participants were followed up for the composite primary endpoint of vascular death or hospitalisation for non-fatal myocardial infarction or non-fatal stroke. Endpoints were identified by participant report or record linkage to National Health Service datasets and were adjudicated by a committee masked to treatment allocation. The primary endpoint was assessed as the time to first occurrence of an event in the intention-to-treat population (ie, all participants randomly assigned to a treatment group). Safety was assessed in all participants who submitted at least one follow-up questionnaire. The study is registered with EudraCT (2011-001968-21) and ISRCTN (18157641), and is now complete. FINDINGS Between Dec 17, 2011, and June 5, 2018, 24 610 individuals were screened and 21 104 were randomly assigned to evening (n=10 503) or morning (n=10 601) dosing groups. Mean age at study entry was 65·1 years (SD 9·3); 12 136 (57·5%) participants were men; 8968 (42·5%) were women; 19 101 (90·5%) were White; 98 (0·5%) were Black, African, Caribbean, or Black British (ethnicity was not reported by 1637 [7·8%] participants); and 2725 (13·0%) had a previous cardiovascular disease. By the end of study follow-up (March 31, 2021), median follow-up was 5·2 years (IQR 4·9-5·7), and 529 (5·0%) of 10 503 participants assigned to evening treatment and 318 (3·0%) of 10 601 assigned to morning treatment had withdrawn from all follow-up. A primary endpoint event occurred in 362 (3·4%) participants assigned to evening treatment (0·69 events [95% CI 0·62-0·76] per 100 patient-years) and 390 (3·7%) assigned to morning treatment (0·72 events [95% CI 0·65-0·79] per 100 patient-years; unadjusted hazard ratio 0·95 [95% CI 0·83-1·10]; p=0·53). No safety concerns were identified. INTERPRETATION Evening dosing of usual antihypertensive medication was not different from morning dosing in terms of major cardiovascular outcomes. Patients can be advised that they can take their regular antihypertensive medications at a convenient time that minimises any undesirable effects. FUNDING British Heart Foundation.
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Affiliation(s)
- Isla S Mackenzie
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Amy Rogers
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Neil R Poulter
- School of Public Health, Imperial College London, London, UK
| | - Bryan Williams
- NIHR University College London Hospitals Biomedical Research Centre and University College London, London, UK
| | | | - David J Webb
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ian Ford
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - David A Rorie
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Greg Guthrie
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - J W Kerr Grieve
- Department of Neurology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Filippo Pigazzani
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Peter M Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Robin Young
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- The Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Allan D Struthers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Chim C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Thomas M MacDonald
- MEMO Research, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
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Bedtime dosing of antihypertensive medications: systematic review and consensus statement: International Society of Hypertension position paper endorsed by World Hypertension League and European Society of Hypertension. J Hypertens 2022; 40:1847-1858. [PMID: 35983870 DOI: 10.1097/hjh.0000000000003240] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Antihypertensive drug therapy is one of the most efficient medical interventions for preventing disability and death globally. Most of the evidence supporting its benefits has been derived from outcome trials with morning dosing of medications. Accumulating evidence suggests an adverse prognosis associated with night-time hypertension, nondipping blood pressure (BP) profile and morning BP surge, with increased incidence of cardiovascular events during the first few morning hours. These observations provide justification for complete 24-h BP control as being the primary goal of antihypertensive treatment. Bedtime administration of antihypertensive drugs has also been proposed as a potentially more effective treatment strategy than morning administration. This Position Paper by the International Society of Hypertension reviewed the published evidence on the clinical relevance of the diurnal variation in BP and the timing of antihypertensive drug treatment, aiming to provide consensus recommendations for clinical practice. Eight published outcome hypertension studies involved bedtime dosing of antihypertensive drugs, and all had major methodological and/or other flaws and a high risk of bias in testing the impact of bedtime compared to morning treatment. Three ongoing, well designed, prospective, randomized controlled outcome trials are expected to provide high-quality data on the efficacy and safety of evening or bedtime versus morning drug dosing. Until that information is available, preferred use of bedtime drug dosing of antihypertensive drugs should not be routinely recommended in clinical practice. Complete 24-h control of BP should be targeted using readily available, long-acting antihypertensive medications as monotherapy or combinations administered in a single morning dose.
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Nagasawa H, Omori K, Ota S, Muramatsu KI, Ishikawa K, Yanagawa Y. Potential effects of regular use of antihypertensive drugs for in-hospital delirium in geriatric patients with trauma. Sci Rep 2022; 12:12737. [PMID: 35882973 PMCID: PMC9325788 DOI: 10.1038/s41598-022-17182-3] [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: 04/04/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022] Open
Abstract
Although the regular administration of antihypertensive drugs is a risk factor for falls in older adults, whether their anti-inflammatory effects confer a survival benefit in older adults remains unknown. This single-center retrospective cohort study examined patients with trauma aged ≥ 65 admitted to our hospital between January 2018 and December 2020. Patients who had not received antihypertensive drugs before admission (i.e., AHT(−) group) and those who had received the drugs (i.e., AHT(+) group) were compared using a 1:1 propensity score-matched analysis. The primary outcome was 28-day mortality, and the secondary outcomes were in-hospital mortality and the incidence of complications during the hospital stay. In total, 637 patients were analyzed. After propensity score matching, each study group had 223 patients. No significant difference was observed in the primary outcome (28-day mortality: AHT(−) group, 3.6% vs. AHT(+) group, 3.6%; adjusted relative risk: 1.00, 95% confidence interval (CI): 0.38–2.62); only the in-hospital incidence of delirium was significantly low in the AHT(+) group (25.1% vs. 13.9%; adjusted relative risk: 0.55, 95% CI: 0.37–0.82). Overall, the regular use of antihypertensive drugs did not affect outcomes in geriatric trauma patients; however, the incidence of delirium was reduced in those regularly receiving antihypertensive drugs.
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Affiliation(s)
- Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan.
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Soichirou Ota
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Ken-Ichi Muramatsu
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, 1129 Nagaoka, Izunokuni City, Shizuoka, 410-2295, Japan
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Biswas I, Adebusoye B, Chattopadhyay K. Risk factors for falls among older adults in India: A systematic review and meta-analysis. Health Sci Rep 2022; 5:e637. [PMID: 35774830 PMCID: PMC9213836 DOI: 10.1002/hsr2.637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/12/2022] [Accepted: 02/17/2022] [Indexed: 12/19/2022] Open
Abstract
Background and Aim Falls are common among older adults in India. Several primary studies on its risk factors have been conducted in India. However, no systematic review has been conducted on this topic. Thus, the objective of this systematic review was to synthesize the existing evidence on the risk factors for falls among older adults in India. Methods JBI and Preferred Reporting Items for Systematic Reviews and Meta-Analyse guidelines were followed, and two independent reviewers were involved in the process. This review included observational studies conducted among older adults (aged ≥ 60 years) residing in India, reporting any risk factor for falls as exposure and unintentional fall as the outcome. MEDLINE, EMBASE, PsycInfo, CINAHL, and ProQuest Dissertations and Theses were searched until September 24, 2020. Where possible, data were synthesized using random-effects meta-analysis. Results The literature search yielded 3445 records. Twenty-two studies met the inclusion criteria of this systematic review, and 19 studies were included in the meta-analysis. Out of the 22 included studies in the systematic review, 12 (out of 18) cross-sectional studies, two case-control studies, and two cohort studies met more than 70% criteria in the respective Joanna Briggs Institute (JBI) checklists. Risk factors for falls among older adults in India included sociodemographic factors, environmental factors, lifestyle factors, physical and/or mental health conditions, and medical interventions. Conclusions This systematic review and meta-analysis provided a holistic picture of the problem in India by considering a range of risk factors such as sociodemographic, environmental, lifestyle, physical and/or mental health conditions and medical intervention. These findings could be used to develop falls prevention interventions for older adults in India. Systematic Review and Meta‐Analysis Registration The systematic review and meta-analysis protocol was registered with PROSPERO (registration number-CRD42020204818).
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Affiliation(s)
- Isha Biswas
- Division of Epidemiology and Public Health, School of MedicineUniversity of NottinghamNottinghamUnited Kingdom
| | - Busola Adebusoye
- Division of Epidemiology and Public Health, School of MedicineUniversity of NottinghamNottinghamUnited Kingdom
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of MedicineUniversity of NottinghamNottinghamUnited Kingdom
- The Nottingham Centre for Evidence‐Based Healthcare: A JBI Centre of ExcellenceNottinghamUnited Kingdom
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13
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O'Donoghue P, O'Halloran A, Kenny RA, Romero-Ortuno R. Older adults identified as frail by Frailty Index and FRAIL scale who were intensively treated for hypertension were at increased risk of 2-year adverse health outcomes in The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13522.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Frailty is associated with adverse health outcomes. In frail older adults, blood pressure (BP) treated intensively may result in side effects including orthostatic hypotension, falls or fractures. We hypothesised that frail older adults, with BP treated below the threshold of the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guideline (<130/70 mmHg), could be associated with adverse health outcomes. Methods: Data was gathered from participants in Wave 1 (W1) of The Irish Longitudinal Study on Ageing (TILDA) who were aged ≥65 years and on treatment for hypertension. Frail classifications as per a 32-item Frailty Index (FI) and FRAIL (Fatigue, Resistance, Ambulation, Illnesses & Loss of Weight) scale were compared in their ability to predict W2 (2-year) adverse outcomes associated with intensive BP control (‘low’: <130/70 mmHg vs. ‘high’: ≥130/70 mmHg). We created eight participant groups based on frailty-BP status. W2 outcomes were analysed using adjusted binary logistic regression models. Results: In W1, 1,920 participants were included. Of these 1,274 had complete FI-BP and 1,276 FRAIL-BP data. The frail by FI treated low and frail by FRAIL treated low had increased risk of hospitalisation, heart failure and falls/fracture by W2. The frail by FRAIL treated low also had increased risk of mortality by W2. The frail by FI treated high had increased risk of syncope and falls/fractures. The non-frail by FI or FRAIL did not have increased risk of any of the adverse outcomes studied. Conclusions: FI and FRAIL captured increased risk of adverse health outcomes when BP was treated below the current ESC/ESH threshold. FI and FRAIL could be more useful than other frailty identification tools to signal risks associated with tighter BP control in frail older adults. Hypertension management guidelines should specify which frailty identification tools clinicians should use to help them make personalised treatment decisions.
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Yu DS, Kim SY. Changes in Postural Control Ability after Wearing Corrective Glasses for Distance in Older Adults and Their Causes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116643. [PMID: 35682228 PMCID: PMC9180575 DOI: 10.3390/ijerph19116643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/27/2022] [Accepted: 05/28/2022] [Indexed: 12/04/2022]
Abstract
Deterioration of postural control in older adults is unavoidable due to age-associated degeneration of the visual system. Our study objective was therefore to verify whether there is a positive effect on postural control ability after providing older adults, whose postural control function had deteriorated, with corrective glasses to correct refractive errors. Twenty-seven participants, 66 to 90 years of age, were included in this study. Stability index, synchronization index, and sway power index were measured by using the TETRAX balance system and comparatively analyzed before and after wearing the corrective glasses for distance. The stability index after wearing corrective glasses significantly decreased compared to before wearing them (p < 0.05). Four synchronization areas, among six, showed a significant increase in the synchronization index after wearing corrective glasses compared to before wearing them (p < 0.05). The sway power index significantly decreased in the mid−high and the high frequency after wearing the corrective glasses (p < 0.05). Optimal visual information can be obtained through the correction of residual refractive errors, eliciting a positive effect on the overall posture control by improving the sensory integration ability with the somatic nervous system responsible for posture control, maximizing the lower extremity motor function of the elderly.
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Affiliation(s)
| | - Sang-Yeob Kim
- Correspondence: ; Tel.: +82-33-540-3413; Fax: +82-33-540-3419
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15
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O'Donoghue P, O'Halloran AM, Kenny RA, Romero-Ortuno R. Do the frail experience more adverse events from intensive blood pressure control? A 2-year prospective study in the Irish Longitudinal Study on Ageing (TILDA). EClinicalMedicine 2022; 45:101304. [PMID: 35243271 PMCID: PMC8860911 DOI: 10.1016/j.eclinm.2022.101304] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/20/2022] [Accepted: 01/28/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines for management of hypertension in adults aged ≥65 years recommend a blood pressure (BP) treatment target of 130-139/70-79 mmHg if tolerated. Randomised controlled trials have advocated for lower BP, but this may have adverse outcomes in the frail. Yet, definitions of frailty vary. METHODS Using a prospective, observational study design, we compared two frailty classifications in their ability to predict short-term adverse outcomes associated with intensive BP control (<130/70 mmHg) in The Irish Longitudinal Study on Ageing (TILDA). Data from participants aged ≥65 treated for hypertension in Wave 1 (W1) between October 2009 and June 2011 were analysed. Frailty was identified by Frailty Phenotype (FP) and the Clinical Frailty Scale (CFS). We formulated 8 participant groups based on frailty-BP combinations. Outcomes at wave 2 (W2) in 2012-2013 were analysed with adjusted binary logistic regression models. FINDINGS Of 1920 W1 participants aged ≥65 and treated for hypertension, 1229 had full BP/FP and 1282 BP/CFS data. While the FP only identified risk of hospitalisation associated with intensive BP treatment, intensively treated frail-by-CFS participants had no increased or decreased risk of adverse outcomes, but those treated above the target had a higher risk of falls/fractures. In the non-frail by FP, intensive blood pressure treatment was associated with reduced risk of falls/fractures. INTERPRETATION Different frailty classifications may have different prognostic implications for the purpose of the application of hypertension management guidelines. Our study had limited power due to low frailty prevalences, so further research is needed. Guidelines should specify the recommended frailty identification method/s. In the frail, therapy personalisation is needed.
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Affiliation(s)
- Patrick O'Donoghue
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, St. James's Hospital, Mercer's Institute for Successful Ageing, James's Street, Dublin 8, Dublin, Ireland
- Corresponding author at: Discipline of Medical Gerontology, St. James's Hospital, Mercer's Institute for Successful Ageing, James's Street, Dublin 8, Dublin, Ireland.
| | - Aisling M. O'Halloran
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, St. James's Hospital, Mercer's Institute for Successful Ageing, James's Street, Dublin 8, Dublin, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, St. James's Hospital, Mercer's Institute for Successful Ageing, James's Street, Dublin 8, Dublin, Ireland
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16
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Canoy D, Harvey NC, Prieto-Alhambra D, Cooper C, Meyer HE, Åsvold BO, Nazarzadeh M, Rahimi K. Elevated blood pressure, antihypertensive medications and bone health in the population: revisiting old hypotheses and exploring future research directions. Osteoporos Int 2022; 33:315-326. [PMID: 34642814 PMCID: PMC8813726 DOI: 10.1007/s00198-021-06190-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022]
Abstract
Blood pressure and bone metabolism appear to share commonalities in their physiologic regulation. Specific antihypertensive drug classes may also influence bone mineral density. However, current evidence from existing observational studies and randomised trials is insufficient to establish causal associations for blood pressure and use of blood pressure-lowering drugs with bone health outcomes, particularly with the risks of osteoporosis and fractures. The availability and access to relevant large-scale biomedical data sources as well as developments in study designs and analytical approaches provide opportunities to examine the nature of the association between blood pressure and bone health more reliably and in greater detail than has ever been possible. It is unlikely that a single source of data or study design can provide a definitive answer. However, with appropriate considerations of the strengths and limitations of the different data sources and analytical techniques, we should be able to advance our understanding of the role of raised blood pressure and its drug treatment on the risks of low bone mineral density and fractures. As elevated blood pressure is highly prevalent and blood pressure-lowering drugs are widely prescribed, even small effects of these exposures on bone health outcomes could be important at a population level.
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Affiliation(s)
- D Canoy
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House 1F, George St., Oxford, OX1 2BQ, UK.
- NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - N C Harvey
- MRC Life Course Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Cooper
- NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- MRC Life Course Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H E Meyer
- Department of Community Medicine and Global Health, Faculty of Medicine, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - B O Åsvold
- Department of Endocrinology, Clinic of Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Public Health and Nursing, K.G. Jebsen Center for Genetic Epidemiology, Norwegian University of Science and Technology, Trondheim, Norway
| | - M Nazarzadeh
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House 1F, George St., Oxford, OX1 2BQ, UK
| | - K Rahimi
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Hayes House 1F, George St., Oxford, OX1 2BQ, UK
- NIHR Oxford Biomedical Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Fahimfar N, Yousefi S, Noorali S, Gharibzadeh S, Sanjari M, Khalagi K, Mehri A, Shafiee G, Heshmat R, Nabipour I, Amini A, Darabi A, Heidari G, Larijani B, Ostovar A. The association of cardio-metabolic risk factors and history of falling in men with osteosarcopenia: a cross-sectional analysis of Bushehr Elderly Health (BEH) program. BMC Geriatr 2022; 22:46. [PMID: 35016617 PMCID: PMC8753863 DOI: 10.1186/s12877-021-02657-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/24/2021] [Indexed: 02/08/2023] Open
Abstract
Background Osteosarcopenia, defined as sarcopenia plus osteopenia/osteoporosis, may increase the risk of fractures and affects morbidity and mortality in the older population. Falling is also common in the elderly and increases the risk of fractures and mortality. We examined the association of cardio-metabolic risk factors with a history of falling in osteosarcopenic men. Methods We used the baseline data of the Bushehr Elderly Health (BEH) program. Osteosarcopenia was defined as having both sarcopenia (reduced skeletal muscle mass plus low physical performance and/or low muscle strength) and osteopenia/osteoporosis (T-score ≤ − 1.0). Falling was defined as a self-reported history of an unintentional down on the ground during the previous year before the study. We used logistic regression analysis to estimate the adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) to quantify the associations. Results All elderly men diagnosed with osteosarcopenia (n = 341), with a mean age of 73.3(±7.4) years, were included. Almost 50(14.7%) participants reported falling. Age showed a positive association with falling (AOR: 1.09, 95%CI: 1.04–1.14). An increase of 10 mmHg in systolic blood pressure(SBP), reduces the odds of falling by 26%(AOR:0.74, 95%CI:0.62–0.89), while a positive association was detected for fasting plasma glucose (FPG), as 10 mg/dl increase in the FPG, raises the chance of falling by 14%(AOR = 1.14, 95%CI:1.06,1.23). Hypertriglyceridemia was inversely associated with falling (AOR = 0.33, 95% CI: 0.12, 0.89). Conclusions Falling is a major public health problem in rapidly aging countries, especially in individuals with a higher risk of fragility fractures. Older age-raised fasting plasma glucose and low SBP are associated with falling in osteosarcopenic patients. Considering the higher risk of fracture in osteosarcopenic men, comprehensive strategies are needed to prevent fall-related injuries in this high-risk population.
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Affiliation(s)
- Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shakiba Yousefi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Noorali
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Safoora Gharibzadeh
- Department of Epidemiology and Biostatistics, Pasteur Institute of Iran, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Khalagi
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Mehri
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Iraj Nabipour
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Azam Amini
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Amirhossein Darabi
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Gholamreza Heidari
- Deputy for Education, Ministry of health and medical education, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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18
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Tantisattamo E, Hamiduzzaman A, Sohn P, Ahdoot R, Hanna RM. Reconciling Systolic Blood Pressure Intervention Trial with Eighth Joint National Commission: a nuanced view of optimal hypertension control in the chronic kidney disease population. Curr Opin Nephrol Hypertens 2022; 31:57-62. [PMID: 34750334 DOI: 10.1097/mnh.0000000000000759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Universally lowering blood pressure (BP) may adversely affect some populations especially in the older population. Recent landmark trials revealed cardiovascular benefits of tight controlling systolic BP (SBP) more than several recent BP targets. Implementing the evidence from the studies and guidelines in some populations is reviewed. RECENT FINDINGS Eighth Joint National Commission (JNC-8) on hypertension issued conservative guidelines that provided an evolutionary change to BPcontrol in the elderly. However, intensive BP control with SBP < 120 mmHg in Systolic Blood Pressure Intervention Trial (SPRINT) focuses on the improvement of cardiovascular and cerebrovascular outcomes. Although increasingly guidelines are trending toward the SPRINT results, it is noteworthy that not all populations show a favorable outcome with intensive BP control given hypotensive risks to memory, kidney function, orthostasis, and morbidity risks. SUMMARY Some populations may benefit from implementing the more intensive SBP target, whereas others such as elderly hypertensive patients may benefit from a more liberal SBP target. In the spirit of 'Primum non Nocere', we call for and suggest that a marriage of both SPRINT and JNC-8 recommendations be undertaken to champion the most cardiovascular protections for the greatest number of patients possible whereas preventing complications in vulnerable populations such as the elderly. Among the chronic kidney disease (CKD) population, SBP < 120 mmHg may not necessarily lead to favorable CKD outcomes.
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Affiliation(s)
- Ekamol Tantisattamo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
- Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, California
- Multi-Organ Transplant Center, Section of Nephrology, Department of Internal Medicine, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Anum Hamiduzzaman
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
| | - Peter Sohn
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
| | - Rebecca Ahdoot
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
| | - Ramy M Hanna
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine School of Medicine, Orange
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Moin ASM, Nandakumar M, Al-Qaissi A, Sathyapalan T, Atkin SL, Butler AE. Potential Biomarkers to Predict Acute Ischemic Stroke in Type 2 Diabetes. Front Mol Biosci 2021; 8:744459. [PMID: 34926573 PMCID: PMC8671883 DOI: 10.3389/fmolb.2021.744459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/16/2021] [Indexed: 12/30/2022] Open
Abstract
Background and Purpose: Patients with type 2 diabetes (T2D) have increased risk of cardiovascular disease (CVD), encompassing myocardial infarction, stroke, and peripheral vascular disease. We hypothesized that those biomarkers indicative of acute ischemic stroke (AIS) seen in large vessel occlusion (LVO) may also be elevated in T2D and further enhanced by stress conditions; therefore, these proteins represent potentially predictive biomarkers for those T2D patients at high risk of AIS. Methods: We performed an exploratory proteomic analysis in control subjects (n = 23) versus those with type 2 diabetes (T2D) (n = 23) who underwent a hyperinsulinemic clamp study to transient severe hypoglycemia [blood glucose <2.0 mmol/L (36 mg/dl)] in a prospective case-control study. We compared these proteins described as diagnostic and prognostic biomarkers for AIS due to LVO: lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE1), thrombospondin-1 (THBS1), pro-platelet basic protein (PPBP), and cadherin 1 (CDH1). Results: At baseline (BL), PPBP (p < 0.05), THBS1 (p < 0.05), and CDH1 (p < 0.01) were elevated in T2D; LYVE1 was not different between controls and T2D subjects at BL or at subsequent timepoints. PPBP and THBS1 tended to increase at hypoglycemia in both cohorts, though reached significance only in controls (p < 0.05), returning to BL levels post-hypoglycemia. CDH1 levels were higher in T2D at BL, at hypoglycemia and up to 2-h posthypoglycemia, thereafter reverting to BL levels. Conclusion: Elevated levels of PPBP, THBS1, and CDH1, circulatory proteins suggested as biomarkers of AIS due to LVO, may, in T2D patients, be prognostically indicative of a cohort of T2D patients at increased risk of ischaemic stroke. Prospective studies are needed to determine if this reflects future clinical risk. Clinical trial reg. no: NCT03102801.
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Affiliation(s)
- Abu Saleh Md Moin
- Diabetes Research Center (DRC), Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Manjula Nandakumar
- Diabetes Research Center (DRC), Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha, Qatar
| | - Ahmed Al-Qaissi
- Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Heslington, United Kingdom.,Leeds Medical School, Leeds, United Kingdom
| | - Thozhukat Sathyapalan
- Academic Endocrinology, Diabetes and Metabolism, Hull York Medical School, Heslington, United Kingdom
| | - Stephen L Atkin
- Department of Research, Royal College of Surgeons of Ireland, Al Muharraq, Bahrain
| | - Alexandra E Butler
- Department of Research, Royal College of Surgeons of Ireland, Al Muharraq, Bahrain
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20
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Tharmaratnam D, Karayiannis CC, Collyer TA, Arima H, McClure LA, Chalmers J, Anderson CS, Benavente OR, White CL, Algra A, Moran C, Phan TG, Wang WC, Srikanth V. Is Blood Pressure Lowering in the Very Elderly With Previous Stroke Associated With a Higher Risk of Adverse Events? J Am Heart Assoc 2021; 10:e022240. [PMID: 34913363 PMCID: PMC9075242 DOI: 10.1161/jaha.121.022240] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background We investigated whether blood pressure lowering for secondary prevention is associated with a reduction in recurrent stroke risk and/or a higher risk of adverse events in very elderly compared with younger trial participants. Methods and Results This is a random effects meta-analysis of randomized controlled trials of blood pressure lowering for secondary stroke prevention to evaluate age-stratified (<80, ≥80 years) risk of adverse events. Ovid-MEDLINE was searched for trials between 1970 and 2020. Summary-level data were acquired including outcomes of stroke, cardiovascular events, mortality, and adverse events. Seven trials were included comprising 38 596 participants, of whom 2336 (6.1%) were aged ≥80 years. There was an overall reduction in stroke risk in the intervention group compared with controls (risk ratio [RR], 0.90 [95% CI, 0.80, 0.98], I2=49%), and the magnitude of risk reduction did not differ by age subgroup (<80, ≥80 years). There was no increase in the risk of hypotensive symptoms in the intervention group for patients aged <80 years (RR, 1.19 [95% CI, 0.99], 1.44, I2=0%), but there was an increased risk in those ≥80 years (RR, 2.17 [95% CI, 1.22], 3.86, I2=0%). No increase was observed in the risk of falls, syncope, study withdrawal, or falls in either age subgroup. Conclusions Very elderly people in secondary prevention trials of blood pressure lowering have an increased risk of hypotensive symptoms, but with no statistical increase in the risk of falls, syncope, or mortality. However, evidence is lacking for frail elderly with multiple comorbidities who may be more vulnerable to adverse effects of blood pressure lowering.
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Affiliation(s)
- Damien Tharmaratnam
- Department of Medicine Peninsula Health Melbourne Australia.,Peninsula Clinical School Central Clinical School Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia.,Stroke and Ageing Research Group, Medicine School of Clinical Sciences Monash Medical Centre Monash University Melbourne Australia
| | - Christopher C Karayiannis
- Department of Medicine Peninsula Health Melbourne Australia.,Peninsula Clinical School Central Clinical School Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia.,Stroke and Ageing Research Group, Medicine School of Clinical Sciences Monash Medical Centre Monash University Melbourne Australia
| | - Taya A Collyer
- Peninsula Clinical School Central Clinical School Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia
| | - Hisatomi Arima
- Faculty of Medicine The George Institute for Global HealthUniversity of New South Wales Camperdown New South Wales Australia.,Department of Preventive Medicine and Public Health Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics Dornsife School of Public Health Drexel University Philadelphia PA
| | - John Chalmers
- Faculty of Medicine The George Institute for Global HealthUniversity of New South Wales Camperdown New South Wales Australia
| | - Craig S Anderson
- Faculty of Medicine The George Institute for Global HealthUniversity of New South Wales Camperdown New South Wales Australia
| | - Oscar R Benavente
- Division of Neurology Department of Medicine Brain Research Center University of British Columbia Vancouver British Columbia Canada
| | - Carole L White
- School of Nursing University of Texas Health Science Center at San Antonio TX
| | - Ale Algra
- Department of Neurology and Neurosurgery UMC Utrecht Brain Center, and Julius Center for Health Sciences and Primary Care University Medical Center Utrecht and Utrecht University Utrecht The Netherlands
| | - Chris Moran
- Department of Medicine Peninsula Health Melbourne Australia.,Peninsula Clinical School Central Clinical School Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia.,Department of Aged Care The Alfred Melbourne Australia.,Geriatric Medicine Unit Peninsula Health Melbourne Australia
| | - Thanh G Phan
- Stroke Unit Department of Neurosciences Monash Health Melbourne Australia.,Stroke and Ageing Research Group, Medicine School of Clinical Sciences Monash Medical Centre Monash University Melbourne Australia
| | - Wei C Wang
- Department of Medicine Peninsula Health Melbourne Australia.,Peninsula Clinical School Central Clinical School Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia
| | - Velandai Srikanth
- Department of Medicine Peninsula Health Melbourne Australia.,Peninsula Clinical School Central Clinical School Faculty of Medicine, Nursing and Health Sciences Monash University Melbourne Australia.,Stroke Unit Department of Neurosciences Monash Health Melbourne Australia.,Stroke and Ageing Research Group, Medicine School of Clinical Sciences Monash Medical Centre Monash University Melbourne Australia.,Geriatric Medicine Unit Peninsula Health Melbourne Australia
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Thapa R, Garikipati A, Shokouhi S, Hurtado M, Barnes G, Hoffman J, Calvert J, Katzmann L, Mao Q, Das R. Usability of Electronic Health records in Predicting Short-term falls: Machine learning Applications in Senior Care Facilities (Preprint). JMIR Aging 2021; 5:e35373. [PMID: 35363146 PMCID: PMC9015781 DOI: 10.2196/35373] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/16/2022] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Short-term fall prediction models that use electronic health records (EHRs) may enable the implementation of dynamic care practices that specifically address changes in individualized fall risk within senior care facilities. Objective The aim of this study is to implement machine learning (ML) algorithms that use EHR data to predict a 3-month fall risk in residents from a variety of senior care facilities providing different levels of care. Methods This retrospective study obtained EHR data (2007-2021) from Juniper Communities’ proprietary database of 2785 individuals primarily residing in skilled nursing facilities, independent living facilities, and assisted living facilities across the United States. We assessed the performance of 3 ML-based fall prediction models and the Juniper Communities’ fall risk assessment. Additional analyses were conducted to examine how changes in the input features, training data sets, and prediction windows affected the performance of these models. Results The Extreme Gradient Boosting model exhibited the highest performance, with an area under the receiver operating characteristic curve of 0.846 (95% CI 0.794-0.894), specificity of 0.848, diagnostic odds ratio of 13.40, and sensitivity of 0.706, while achieving the best trade-off in balancing true positive and negative rates. The number of active medications was the most significant feature associated with fall risk, followed by a resident’s number of active diseases and several variables associated with vital signs, including diastolic blood pressure and changes in weight and respiratory rates. The combination of vital signs with traditional risk factors as input features achieved higher prediction accuracy than using either group of features alone. Conclusions This study shows that the Extreme Gradient Boosting technique can use a large number of features from EHR data to make short-term fall predictions with a better performance than that of conventional fall risk assessments and other ML models. The integration of routinely collected EHR data, particularly vital signs, into fall prediction models may generate more accurate fall risk surveillance than models without vital signs. Our data support the use of ML models for dynamic, cost-effective, and automated fall predictions in different types of senior care facilities.
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22
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Ren J, Li G, Zhang L, Zhang N, Ren J. Hypothetical Interventions for Falls Among Older Adults: An Application of the Parametric G-Formula. Front Med (Lausanne) 2021; 8:732136. [PMID: 34568390 PMCID: PMC8457044 DOI: 10.3389/fmed.2021.732136] [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: 06/28/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Falls, which have a higher incidence and mortality due to accidental injuries, are a major global health challenge. The effects of lifestyle factor, health indicator, psychological condition, and functional status interventions on the risk of falls are unknown and the conventional regression model would not adjust for the confounders. This study aimed to evaluate the 4-year risk of falls on the basis of these hypothetical interventions among Chinese older adults. Methods: Data were obtained from 9,692 aged 65 years and over older adults in the China Health and Retirement Longitudinal Study wave, from 2011 to 2015. We used the parametric g-formula to evaluate the risk of falls on the basis of independent hypothetical interventions of sleep duration, social activities, smoking status, drinking status, body mass index (BMI), systolic blood pressure (SBP), vision, depression, activities of daily living (ADL), and their different joint intervention combinations. Results: During the follow-up of 4 years, we documented 1,569 falls. The observed risk of falls was 23.58%. The risk ratios (95% confidence intervals [CIs]) of falls under the intensive hypothetical interventions on increasing sleep duration, participating in more social activities, quit smoking and drinking, reducing BMI and SBP, better vision, alleviating depressive symptoms, and improving ADL capability were 0.93 (0.87–0.96), 0.88 (0.79–0.92), 0.98 (0.95–1.03), 0.97 (0.95–1.02), 0.92 (0.86–1.03), 0.93 (0.87–1.04), 0.86 (0.74–0.91), 0.91 (0.85–0.96), and 0.79 (0.74–0.85), respectively. The feasible and intensive joint hypothetical intervention reduced the 4-year fall risk by 22% (95% CI: 0.52–0.91) and 33% (95% CI: 0.56–0.72), respectively. Conclusions: Hypothetical interventions for increasing sleep duration, participating in more social activities, better vision, alleviating depressive symptoms, and improving ADL capability help protect older adults from falls. Our findings suggest that a combination of lifestyle factors, health indicators, psychological conditions, and functional status may prove to be an effective strategy for preventing falls among older adults.
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Affiliation(s)
- Jiaojiao Ren
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Guangyou Li
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Liju Zhang
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Na Zhang
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
| | - Juan Ren
- Department of Preventive Medicine, Zhuhai Campus of Zunyi Medical University, Zhuhai, China
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Older Adults with Hypertension: Prevalence of Falls and Their Associated Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168257. [PMID: 34444005 PMCID: PMC8392439 DOI: 10.3390/ijerph18168257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 01/04/2023]
Abstract
Falls are prominent health issues among older adults. Among hypertensive older adults, falls may have a detrimental effect on their health and wellbeing. The purpose of this study is to determine the prevalence of falls among hypertensive older adults and to identify the associated factors that contribute to their falls. This was a cross-sectional study conducted among two hundred and sixty-nine hypertensive older adults who were selected via systematic random sampling in two primary health clinics in Kuala Terengganu, Malaysia. Data on their socio-demographic details, their history of falls, medication history and clinical characteristics were collected. Balance and gait were assessed using the Performance Oriented Mobility Assessment (POMA). It was found that 32.2% of participants reported falls within a year. Polypharmacy (adjusted OR 2.513, 95% CI 1.339, 4.718) and diuretics (adjusted OR 2.803, 95% CI 1.418, 5.544) were associated with an increased risk of falls. Meanwhile, a higher POMA score (adjusted OR 0.940, 95% CI 0.886, 0.996) and the number of antihypertensives (adjusted OR 0.473, 95% CI 0.319, 0.700) were associated with a low incidence of falling among hypertensive older adults. Falls are common among hypertensive older adults. Older adults who are taking diuretics and have a polypharmacy treatment plan have a higher incidence of falls. However, older adults taking a higher number of anti-hypertensive medications specifically were not associated with an increased prevalence of falls.
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Kleipool EEF, Rozendaal ES, Mahadew SKN, Kramer MHH, van den Born BJH, Serné EH, Peters MJL, Muller M. The value of ambulatory blood pressure measurement to detect masked diastolic hypotension in older patients treated for hypertension. Age Ageing 2021; 50:1229-1235. [PMID: 33454734 DOI: 10.1093/ageing/afaa287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE assess how many patients with low ambulatory diastolic blood pressure (DBP) are not identified when relying on office DBP alone, and thus have 'masked diastolic hypotension'. DESIGN cross-sectional, retrospective cohort study. SETTING academic hospital. SUBJECTS 848 patients treated for hypertension who received ambulatory blood pressure monitoring (ABPM). METHODS cut-off value between on- and off-target systolic blood pressure (SBP): 140 mmHg. Cut-off for low office and/or ambulatory DBP: DBP ≤ 70 mmHg. 'Masked diastolic hypotension' was defined as office DBP > 70 mmHg and mean ambulatory DBP ≤ 70 mmHg. RESULTS mean age of the sample was 60 ± 13 years, 50% was female, 37% had diabetes, 42% preexisting cardiovascular disease (CVD), mean office blood pressure (BP) was 134/79 mmHg. In all patients (n = 848), low office DBP was present in n = 84(10%), while n = 183(22%) had low ambulatory DBP. In all patients with normal-to-high office DBP (n = 764), n = 122(16%) had 'masked diastolic hypotension'. In this group, ambulatory DBP was 14-19 mmHg lower than office DBP. Patients with low ambulatory DBP were older, had more (cardiovascular) comorbidities, and used more (antihypertensive) drugs. Antihypertensive drugs were lowered or discontinued in 30% of all patients with 'masked diastolic hypotension' due to side effects. CONCLUSIONS 'masked diastolic hypotension' is common among patients treated for hypertension, particularly in older patients with CVD (e.g. coronary artery disease, diabetes), patient groups in which the European Society of Cardiology/Hypertension guideline advises to prevent low DBP. Although it remains to be examined at which BP levels the harms of low DBP outweigh the benefits of lowering SBP, our observations are aimed to increase awareness among physicians.
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Affiliation(s)
- Emma E F Kleipool
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Eva S Rozendaal
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Shaya K N Mahadew
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Mark H H Kramer
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Bert-Jan H van den Born
- Department of Vascular/Internal Medicine, Amsterdam UMC, Location AMC, 1105 AZ Amsterdam, The Netherlands
| | - Erik H Serné
- Department of Vascular/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Mike J L Peters
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Department of Vascular/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Majon Muller
- Department of Geriatric/Internal Medicine, Amsterdam UMC, Location VUmc, 1081 HV Amsterdam, The Netherlands
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Song Y, Deng Y, Li J, Hao B, Cai Y, Chen J, Shi H, Xu W. Associations of falls and severe falls with blood pressure and frailty among Chinese community-dwelling oldest olds: The Chinese Longitudinal Health and Longevity Study. Aging (Albany NY) 2021; 13:16527-16540. [PMID: 34160365 PMCID: PMC8266320 DOI: 10.18632/aging.203174] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/31/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Falls are a leading cause of death among Chinese oldest olds. However, studies on Chinese community-dwelling older adults are lacking. We aimed to identify the associations of falls and severe falls with blood pressure and frailty among Chinese community-dwelling oldest olds. METHODS Cross-sectional analyses were conducted with 6,595 community-dwelling oldest olds (aged ≥80 years) from 22 Chinese provinces from the Chinese Longitudinal Health and Longevity Study (CLHLS). Systolic BP (SBP) and diastolic BP (DBP) were measured twice at participants' homes, and a 38-item frailty index was used to assess the frailty status of participants. Falls and severe falls were confirmed through face-to-face interviews. Multivariate logistic regression was used to investigate the associations of BP and frailty with falls and severe falls. RESULTS The mean participant age was 91.0 years, and 56.1% were female. In total, 24.2% participants had a history of fall and 8.3% had a history of severe falls. The multivariate-adjusted odds ratio (OR) for falls among the oldest old with SBP ≥140 mm Hg compared to those with an SBP of 120-129 mm Hg was 1.20 (95% confidence interval [CI], 1.01-1.44). The adjusted OR for falls among frail participants compared to robust participants was 1.39 (95% CI, 1.02-1.89). DBP and pre-frailty were not associated with falls after multivariate adjustment. SBP, DBP, and frailty status were not associated with severe falls after multivariate adjustment. CONCLUSIONS SBP and frailty but not DBP and pre-frailty are associated with increased odds of falls among Chinese community-dwelling oldest olds.
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Affiliation(s)
- Yujian Song
- Graduate School of Medical School of Chinese PLA, Beijing 100853, China
| | - Yujiao Deng
- Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Jianhua Li
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Benchuan Hao
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Yulun Cai
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianqiao Chen
- Department of Geriatric Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Haiyan Shi
- Department of Gastroenterology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Weihao Xu
- Haikou Cadre's Sanitarium of Hainan Military Region, Haikou 570203, China
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Circadian variations in blood pressure and their implications for the administration of antihypertensive drugs: is dosing in the evening better than in the morning? J Hypertens 2021; 38:1396-1406. [PMID: 32618895 DOI: 10.1097/hjh.0000000000002532] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
: Blood pressure (BP) follows a circadian rhythm with a physiological decrease during the night. Studies have demonstrated that nocturnal BP as well as its dipping pattern during night-time have a significant prognostic importance for mortality and the occurrence of cardiovascular events. Therefore, hypertension management guidelines recommend to ascertain that patients treated for hypertension have well controlled BP values around the clock. To improve hypertension control during the night and eventually further reduce cardiovascular events, it has been proposed by some to prescribe at least one antihypertensive medication at bedtime. In this review, we have examined the data which could support the benefits of prescribing BP-lowering drugs at bedtime. Our conclusion is that there is no convincing evidence that the administration of BP-lowering drugs in the evening provides any significant advantage in terms of quality of BP control, prevention of target organ damage or reduction of cardiovascular events. Before changing practice for unproven benefits, it would be wise to wait for the results of the ongoing trials that are addressing this issue.
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Mahinrad S, Shownkeen M, Sedaghat S, Yaffe K, Hausdorff JM, Lloyd-Jones DM, Gorelick PB, Sorond FA. Vascular health across young adulthood and midlife cerebral autoregulation, gait, and cognition. Alzheimers Dement 2020; 17:745-754. [PMID: 33283978 DOI: 10.1002/alz.12246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION To test the association of vascular health (VH) across young adulthood with midlife dynamic cerebral autoregulation (dCA), gait, and cognition; and to test whether dCA is a modifying factor. METHODS We studied 196 participants from the Coronary Artery Risk Development in Young Adults cohort who were followed over 30 years. VH was assessed at each visit according to American Heart Association recommendations. At year 30, dCA was measured using transcranial Doppler ultrasound and several gait and cognitive domains were assessed. RESULTS Worse VH from baseline through year 7, but not at year 30, was associated with less efficient dCA (all P < .05). Worse VH at all visits was associated with slower gait speed, and at year 7 with worse executive and global cognition (all P < .05). The association of baseline VH and midlife gait, but not cognition, was moderated by dCA (interaction P < .05). CONCLUSIONS VH as early as young adulthood may influence midlife brain health, and dCA may modify this relationship.
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Affiliation(s)
- Simin Mahinrad
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Meghana Shownkeen
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sanaz Sedaghat
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology, University of California San Francisco, San Francisco, California, USA
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sagol School of Neuroscience and Department of Physical Therapy, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University, Chicago, Illinois, USA
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Philip B Gorelick
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Farzaneh A Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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The association of blood pressure with physical frailty and cognitive function in community-dwelling septuagenarians, octogenarians, and nonagenarians: the SONIC study. Hypertens Res 2020; 43:1421-1429. [PMID: 32641853 DOI: 10.1038/s41440-020-0499-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/08/2022]
Abstract
We investigated the association of systolic blood pressure (SBP) level with physical frailty and cognitive function in community-dwelling older Japanese. Using the 'Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians' survey as the baseline, we performed a cross-sectional analysis of people aged 70 ± 1 (n = 1000), 80 ± 1 (n = 978), and 90 ± 1 (n = 272) years. Medical histories and medications were collected via interviews conducted by medical professionals. Blood pressure (BP), grip strength, gait speed, and cognitive function were examined on site. Trend analysis and multiple regression analysis were used to determine the association of the SBP level with physical frailty and cognitive function. The principal finding was that the association of SBP with physical frailty and cognitive function varied depending on characteristics such as age, physical and cognitive function, and antihypertensive medication use. A lower SBP level was associated with a higher prevalence of physical frailty only among 80-year-olds who were on antihypertensive medication. A significant association was found between higher SBP and lower cognitive function among 70-year-olds, while among 90-year-olds, the opposite was found. No association was found among participants who were 80 years old or among participants of all ages without antihypertensive medication. Our finding that an inverted association between SBP and geriatric syndrome exists suggests that the treatment of older patients must be individualized to prevent geriatric syndrome.
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29
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Psara E, Pentieva K, Ward M, McNulty H. Critical review of nutrition, blood pressure and risk of hypertension through the lifecycle: do B vitamins play a role? Biochimie 2020; 173:76-90. [PMID: 32289470 DOI: 10.1016/j.biochi.2020.03.016] [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] [Received: 11/04/2019] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022]
Abstract
Hypertension is the leading cause of preventable mortality worldwide, contributing to over 9 million deaths per annum, predominantly owing to cardiovascular disease. The association of obesity, physical inactivity and alcohol with elevated blood pressure (BP) is firmly established. Weight loss or other dietary strategies, such as the Dietary Approaches to Stop Hypertension (DASH) diet, have been shown to be effective in lowering BP. Additionally, specific nutrients are recognised to contribute to BP, with higher sodium intake linked with an increased risk of hypertension, while potassium is associated with a reduced risk of hypertension. Of note, emerging evidence has identified a novel role for one-carbon metabolism and the related B vitamins, particularly riboflavin, in BP. Specifically in adults genetically at risk of developing hypertension, owing to the common C677T polymorphism in MTHFR, supplemental riboflavin (co-factor for MTHFR) was shown in randomised trials to lower systolic BP by up to 13 mmHg. A BP response to intervention of this magnitude could have important clinical impacts, given that a reduction in systolic BP of 10 mmHg is estimated to decrease stroke risk by 40%. This review aims to explore the factors contributing to hypertension across the lifecycle and to critically evaluate the evidence supporting a role for nutrition, particularly folate-related B vitamins, in BP and risk of hypertension. In addition, gaps in our current knowledge that warrant future research in this area, will be identified.
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Affiliation(s)
- Elina Psara
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, BT52 1SA, United Kingdom
| | - Kristina Pentieva
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, BT52 1SA, United Kingdom
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, BT52 1SA, United Kingdom
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, BT52 1SA, United Kingdom.
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30
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Cordovilla-Guardia S, Molina TB, Franco-Antonio C, Santano-Mogena E, Vilar-López R. Association of benzodiazepines, opioids and tricyclic antidepressants use and falls in trauma patients: Conditional effect of age. PLoS One 2020; 15:e0227696. [PMID: 31940406 PMCID: PMC6961940 DOI: 10.1371/journal.pone.0227696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/26/2019] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The relationship between benzodiazepines, opioids and tricyclic antidepressants and trauma is of great importance because of increased consumption and the growing evidence of a positive association among older adults. The objective of this study was to determine the effect size of the association between the consumption of psychotropic medications /opioids and falls in patients who have suffered trauma by studying the role of other variables in this relationship. METHOD From 2011 to 2016, the presence of benzodiazepines, opioids and tricyclic antidepressants and other drugs in 1060 patients admitted for trauma at a level I trauma hospital was analysed. Multivariate models were used to measure the adjusted effect size of the association between consumption of benzodiazepines, opioids and tricyclic antidepressants and falls, and the effect of age on this association was studied. RESULTS A total of 192 patients tested positive for benzodiazepines, opioids and tricyclic antidepressants, with same-level falls being the most frequent mechanism of injury in this group (40.1%), with an odds ratio of 1.96 (1.40-2.75), p < 0.001. Once other covariates were introduced, this association was not observed, leaving only age, gender (woman) and, to a lesser extent, sensory conditions as variables associated with falls. Age acted as an effect modifier between benzodiazepines, opioids and tricyclic antidepressants and falls, with significant effect sizes starting at 51.9 years of age. CONCLUSIONS The association between the consumption of benzodiazepines, opioids and tricyclic antidepressants and falls in patients admitted for trauma is conditioned by other confounding variables, with age being the most influential confounding variable.
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Affiliation(s)
- Sergio Cordovilla-Guardia
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
- Health and Care Research Group (GISyC), University of Extremadura, Cáceres, Spain
| | | | - Cristina Franco-Antonio
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
- Health and Care Research Group (GISyC), University of Extremadura, Cáceres, Spain
| | - Esperanza Santano-Mogena
- Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, Cáceres, Spain
- Health and Care Research Group (GISyC), University of Extremadura, Cáceres, Spain
| | - Raquel Vilar-López
- Mind, Brain and Behavior Research Centre, University of Granada, Granada, Spain
- Andalusian Observatory on Drugs and Addictions, Granada, Spain
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Forrester SJ, Dolmatova EV, Griendling KK. An acceleration in hypertension-related mortality for middle-aged and older Americans, 1999-2016: An observational study. PLoS One 2020; 15:e0225207. [PMID: 31940349 PMCID: PMC6961854 DOI: 10.1371/journal.pone.0225207] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/29/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hypertension-related mortality has been increasing in recent years; however, limited information exists concerning rate, temporal, secular, and geographic trends in the United States. METHODS AND RESULTS Using CDC death certificate data spanning 1999-2016, we sought to delineate trends in deaths attributable to an underlying cause of hypertension using joinpoint regression and proportion testing. From 1999-2016, the hypertension-related mortality rate increased by 36.4% with an average annual percent change (AAPC) of 1.8% for individuals ≥ 35 years of age. Interestingly, there was a notable acceleration in the AAPC of hypertension mortality between 2011 and 2016 (2.7% per year). This increase was due to a significant uptick in mortality for individuals ≥ 55 years of age with the greatest AAPC occurring in individuals 55-64 (4.5%) and 65-74 (5.1%) years of age. Increased mortality and AAPC were pervasive throughout sex, ethnicity, and White and American Indian or Alaska Native race, but not Black or African American race. From 2011-2016, there were significant increases in AAPC for hypertension-related mortality with contributing causes of atrial fibrillation, heart failure, diabetes, obesity, and vascular dementia. Elevated mortality was observed for conditions with a contributing cause of hypertension that included chronic obstructive pulmonary disease, diabetes, Alzheimer's, Parkinson's, and all types of falls. Geographically, increases in AAPCs and mortality rates were observed for 25/51 States between 2011 and 2016. CONCLUSIONS Our results indicate hypertension-related mortality may have accelerated since 2011 for middle-aged and older Americans, which may create new challenges in care and healthcare planning.
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Affiliation(s)
- Steven J. Forrester
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, United States of America
| | - Elena V. Dolmatova
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, United States of America
| | - Kathy K. Griendling
- Department of Medicine, Division of Cardiology, Emory University, Atlanta, Georgia, United States of America
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Dominic E, Brozek W, Peter RS, Fromm E, Ulmer H, Rapp K, Concin H, Nagel G. Metabolic factors and hip fracture risk in a large Austrian cohort study. Bone Rep 2020; 12:100244. [PMID: 31970265 PMCID: PMC6965713 DOI: 10.1016/j.bonr.2020.100244] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 12/11/2022] Open
Abstract
To explore the association of incident hip fractures with metabolic syndrome (MetS) and its single components, we designed a prospective cohort study of hip fracture incidence among 117,053 participants of a population-based health surveillance program in Vorarlberg, the westernmost Austrian province. Incident hip fractures were recorded between 5 and 10 years after inclusion at baseline from 2003 to 2009. Applying Cox proportional hazard models for each MetS component and for a composite z-score for MetS, hazards for fracture were estimated in quintiles, as continuous z-score variables, and as pathological cut off values. Mean age was 50.1 ± 15.6 years at baseline, 5-10 years after which 947 incident hip fractures occurred. An association of a higher composite MetS score with decreased hip fracture risk was observed in women (HR 0.80, 95%-CI 0.88-0.96, p < 0.01) which disappeared upon adjustment for BMI. BMI was inversely associated with hip fracture risk in women and men (HR for the highest compared with the lowest quintile: 0.83 (95%-CI: 0.63-1.10, p trend < 0.05) and 0.55 (95%-CI: 0.38-0.79, p trend < 0.001), respectively). Only in women, hip fracture risk was reduced at high cholesterol levels (HR for the highest relative to the lowest quintile: 0.64, 95%-CI: 0.48-0.84, p trend < 0.05) and in hypercholesterolemic patients (HR 0.82, 95%-CI: 0.67-0.99, p < 0.05), but elevated in hyperglycemic patients (HR 1.33, 95%-CI: 1.05-1.70, p < 0.05). Hypertriglyceridemia was associated with increased male hip fracture risk (HR 1.33, 95%-CI: 1.03-1.72, p < 0.05). The inverse association between the MetS and hip fracture risk is mainly driven by one single component, namely BMI.
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Affiliation(s)
- Erlangga Dominic
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900 Bregenz, Austria
| | - Wolfgang Brozek
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900 Bregenz, Austria
| | - Raphael Simon Peter
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Ella Fromm
- Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Hanno Ulmer
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900 Bregenz, Austria.,Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Schöpfstr. 41/1, 6020 Innsbruck, Austria
| | - Kilian Rapp
- Clinic for Geriatric Rehabilitation, Robert-Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Hans Concin
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900 Bregenz, Austria
| | - Gabriele Nagel
- Agency for Preventive and Social Medicine, Rheinstr. 61, 6900 Bregenz, Austria.,Institute of Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081 Ulm, Germany
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Mahinrad S, Kurian S, Garner CR, Sedaghat S, Nemeth AJ, Moscufo N, Higgins JP, Jacobs DR, Hausdorff JM, Lloyd-Jones DM, Sorond FA. Cumulative Blood Pressure Exposure During Young Adulthood and Mobility and Cognitive Function in Midlife. Circulation 2019; 141:712-724. [PMID: 31747780 DOI: 10.1161/circulationaha.119.042502] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High blood pressure (BP) is a known risk factor for mobility and cognitive impairment in older adults. This study tested the association of cumulative BP exposure from young adulthood to midlife with gait and cognitive function in midlife. Furthermore, we tested whether these associations were modified by cerebral white matter hyperintensity (WMH) burden. METHODS We included 191 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults), a community-based cohort of young individuals followed over 30 years. Cumulative BP was calculated as the area under the curve (mm Hg×years) from baseline up to year 30 examination. Gait and cognition were assessed at the year 30 examination. Cerebral WMH was available at year 30 in a subset of participants (n=144) who underwent magnetic resonance imaging. Multiple linear regression models were used to assess the association of cumulative BP exposure with gait and cognition. To test effect modification by WMH burden, participants were stratified at the median of WMH and tested for interaction. RESULTS Higher cumulative systolic and diastolic BPs were associated with slower walking speed (both P=0.010), smaller step length (P=0.011 and 0.005, respectively), and higher gait variability (P=0.018 and 0.001, respectively). Higher cumulative systolic BP was associated with lower cognitive performance in the executive (P=0.021), memory (P=0.015), and global domains (P=0.010), and higher cumulative diastolic BP was associated with lower cognitive performance in the memory domain (P=0.012). All associations were independent of socio-demographics and vascular risk factors (body mass index, smoking, diabetes mellitus and total cholesterol). The association between cumulative BP and gait was moderated by WMH burden (interaction P<0.05). However, the relation between cumulative BP and cognitive function was not different based on the WMH burden (interaction P>0.05). CONCLUSIONS Exposure to higher BP levels from young to midlife is associated with worse gait and cognitive performance in midlife. Furthermore, WMH moderates the association of cumulative BP exposure with gait, but not with cognitive function in midlife. The mechanisms underpinning the impact of BP exposure on brain structure and function must be investigated in longitudinal studies using a life course approach.
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Affiliation(s)
- Simin Mahinrad
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shawn Kurian
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Chaney R Garner
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sanaz Sedaghat
- Preventive Medicine (S.S., D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexander J Nemeth
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL.,Department of Radiology, Division of Neuroradiology (A.J.N.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nicola Moscufo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (N.M.)
| | - James P Higgins
- Radiology and Biomedical Engineering (J.P.H.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (D.R.J.Jr.)
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel (J.M.H.).,Sagol School of Neuroscience and Department of Physical Therapy, Tel Aviv University, Israel (J.M.H.).,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University, Chicago, IL (J.M.H.)
| | - Donald M Lloyd-Jones
- Preventive Medicine (S.S., D.M.L.-J.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Farzaneh A Sorond
- Departments of Neurology (S.M., S.K., C.R.G., A.J.N., F.A.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
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Yin J, Lu X, Qian Z, Xu W, Zhou X. New insights into the pathogenesis and treatment of sarcopenia in chronic heart failure. Am J Cancer Res 2019; 9:4019-4029. [PMID: 31281529 PMCID: PMC6592172 DOI: 10.7150/thno.33000] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022] Open
Abstract
Sarcopenia is an age-related geriatric syndrome that is characterized by a progressive loss of muscle mass, strength and function. Chronic heart failure (CHF), the final stage of various cardiovascular diseases, may be closely correlated with the occurrence of sarcopenia. Accumulating evidence has demonstrated that CHF can promote the development of sarcopenia through multiple pathophysiological mechanisms, including malnutrition, inflammation, hormonal changes, oxidative stress, autophagy, and apoptosis. Additionally, CHF can aggravate the adverse outcomes associated with sarcopenia, including falls, osteoporosis, frailty, cachexia, hospitalization, and mortality. Sarcopenia and CHF are mutually interacting clinical syndromes. Patients with these two syndromes seem to endure a double burden, with no particularly effective way to hinder their progression. However, the combination of physical exercise, nutritional supplements, and drug therapy may counteract the development of these maladies. In this review, we will summarize the latest progress in the pathogenesis and treatment of sarcopenia in patients with CHF.
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Fernandes M, Olde Rikkert MGM. The new US and European guidelines in hypertension: A multi-dimensional analysis. Contemp Clin Trials 2019; 81:44-54. [PMID: 31002956 DOI: 10.1016/j.cct.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/30/2019] [Accepted: 04/11/2019] [Indexed: 11/29/2022]
Abstract
The Systolic Blood Pressure Intervention Trial (SPRINT) compared the clinical outcomes between target systolic blood pressure (SBP) levels between 140 and 120 mmHg or lower. Both,the 2017 ACC/AHA and the 2018 ESC/ESH guidelines in hypertension are derived from the SPRINT trial and advise initiation and/or intensification of treatment at lower blood pressure thresholds. The ACC/AHA guidance supersedes the 2014 Eight Joint National Committee guideline (JNC-8) which advised initiation of treatment when the BP was 140/90 mmHg or higher; in adults 60 years or over, the target was 150/90 mmHg. Compared to JNC-8, the new guidelines lower the SBP target by 10 mmHg in patients under age of 60 years, and by 20 mmHg in the elderly. We performed a qualitative multi-dimensional analysis in order to answer two key questions: will the new guidelines deliver the stated benefits? and, will translation to the clinic be simple, risk-free, and affordable? A major investment by national healthcare administrations will be necessary for the initiation and support of this program but this decision can only be justified by a valid expectation of clinical benefit. At this time, a definitive answer is not available and a "wait and see" attitude appears appropriate and reasonable. In the interim, efforts are best directed to the immediate problem of untreated hypertension worldwide.
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Sim JJ, Zhou H, Bhandari S, Wei R, Brettler JW, Tran-Nguyen J, Handler J, Shimbo D, Jacobsen SJ, Reynolds K. Low Systolic Blood Pressure From Treatment and Association With Serious Falls/Syncope. Am J Prev Med 2018; 55:488-496. [PMID: 30166081 DOI: 10.1016/j.amepre.2018.05.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/18/2018] [Accepted: 05/24/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION With the growing emphasis on intensive blood pressure control, the potential for overtreatment and treatment-related adverse outcomes has become an area of interest. A large representative population within a real-world clinical environment with successful hypertension control rates was used to evaluate serious falls and syncope in people with low-treated systolic blood pressure (SBP). METHODS A cross-sectional study among medically treated hypertensive individuals within the Kaiser Permanente Southern California health system (2014-2015) was performed. Serious fall injuries and syncope were identified using ICD codes based on emergency department and hospitalization diagnoses. SBPs in a 1-year window were used to compare serious falls and syncope among individuals with SBP <110 mmHg vs ≥110 mmHg. Logistic regression was used to evaluate the association between low minimum and mean SBP and serious falls/syncope after adjustment for demographics, comorbidities, and medications. RESULTS In 477,516 treated hypertensive individuals, the mean age was 65 (SD=13) years and the mean SBP was 129 (SD=10) mmHg, with 27% having a minimum SBP <110 mmHg and 3% having mean SBP <110 mmHg. A total of 15,419 (3.2%) individuals experienced a serious fall or syncope or both during the observation window (5.7% among minimum SBP <110 mmHg and 5.4% among mean SBP <110 mmHg). The multivariable ORs for serious falls/syncope were 2.18 (95% CI=2.11, 2.25) for minimum SBP <110 mmHg and 1.54 (95%CI=1.43, 1.66) for mean SBP <110 mmHg compared with SBP ≥110 mmHg. CONCLUSIONS Among treated hypertensive patients, both minimum and mean SBP less than 110 mmHg were associated with serious falls and syncope. Low treatment-related blood pressures deserve consideration given the emphasis on intensive blood pressure control.
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Affiliation(s)
- John J Sim
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
| | - Hui Zhou
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Simran Bhandari
- Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California
| | - Rong Wei
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jeff W Brettler
- Regional Hypertension Program, Kaiser Permanente Southern California, Pasadena, California
| | - Jocelyn Tran-Nguyen
- Regional Hypertension Program, Kaiser Permanente Southern California, Pasadena, California
| | - Joel Handler
- Regional Hypertension Program, Kaiser Permanente Southern California, Pasadena, California
| | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Steven J Jacobsen
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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Sagawa N, Marcum ZA, Boudreau RM, Hanlon JT, Albert SM, O’Hare C, Satterfield S, Schwartz AV, Vinik AI, Cauley JA, Harris TB, Newman AB, Strotmeyer ES. Low blood pressure levels for fall injuries in older adults: the Health, Aging and Body Composition Study. Eur J Ageing 2018; 15:321-330. [PMID: 30310378 PMCID: PMC6156730 DOI: 10.1007/s10433-017-0449-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Fall injuries cause morbidity and mortality in older adults. We assessed if low blood pressure (BP) is associated with fall injuries, including sensitivity analyses stratified by antihypertensive medications, in community-dwelling adults from the Health, Aging and Body Composition Study (N = 1819; age 76.6 ± 2.9 years; 53% women; 37% black). Incident fall injuries (N = 570 in 3.8 ± 2.4 years) were the first Medicare claims event from clinic visit (7/00-6/01) to 12/31/08 with an ICD-9 fall code and non-fracture injury code, or fracture code with/without a fall code. Participants without fall injuries (N = 1249) were censored over 6.9 ± 2.1 years. Cox regression models for fall injuries with clinically relevant systolic BP (SBP; ≤ 120, ≤ 130, ≤ 140, > 150 mmHg) and diastolic BP (DBP; ≤ 60, ≤ 70, ≤ 80, > 90 mmHg) were adjusted for demographics, body mass index, lifestyle factors, comorbidity, and number and type of medications. Participants with versus without fall injuries had lower DBP (70.5 ± 11.2 vs. 71.8 ± 10.7 mmHg) and used more medications (3.8 ± 2.9 vs. 3.3 ± 2.7); all P < 0.01. In adjusted Cox regression, fall injury risk was increased for DBP ≤ 60 mmHg (HR = 1.25; 95% CI 1.02-1.53) and borderline for DBP ≤ 70 mmHg (HR = 1.16; 95% CI 0.98-1.37), but was attenuated by adjustment for number of medications (HR = 1.22; 95% CI 0.99-1.49 and HR = 1.12; 95% CI 0.95-1.32, respectively). Stratifying by antihypertensive medication, DBP ≤ 60 mmHg increased fall injury risk only among those without use (HR = 1.39; 95% CI 1.02-1.90). SBP was not associated with fall injury risk. Number of medications or underlying poor health may account for associations of low DBP and fall injuries.
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Affiliation(s)
- Naoko Sagawa
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
| | - Zachary A. Marcum
- School of Pharmacy, University of Washington, 1959 NE Pacific St, H375G, Box 357630, Seattle, WA 98195 USA
| | - Robert M. Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
| | - Joseph T. Hanlon
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 3471 Fifth Ave, Kaufman Medical Building, Suite 500, Pittsburgh, PA 15213 USA
| | - Steven M. Albert
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
| | - Celia O’Hare
- School of Medicine, Trinity College Dublin, University of Dublin, College Green, Dublin, 2 Ireland
| | - Suzanne Satterfield
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163 USA
| | - Ann V. Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, San Francisco, CA 94158 USA
| | - Aaron I. Vinik
- Strelitz Endocrine and Metabolic Center and Neuroendocrine Unit, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501 USA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
| | - Tamara B. Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute On Aging, National Institute of Health, 7201 Wisconsin Avenue, Gateway Building, Suite 2N300, Bethesda, MD 20814 USA
| | - Anne B. Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 3471 Fifth Ave, Kaufman Medical Building, Suite 500, Pittsburgh, PA 15213 USA
| | - Elsa S. Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
| | - for the Health Aging Body Composition Study
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
- School of Pharmacy, University of Washington, 1959 NE Pacific St, H375G, Box 357630, Seattle, WA 98195 USA
- Division of Geriatric Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, 3471 Fifth Ave, Kaufman Medical Building, Suite 500, Pittsburgh, PA 15213 USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA 15261 USA
- School of Medicine, Trinity College Dublin, University of Dublin, College Green, Dublin, 2 Ireland
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163 USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, San Francisco, CA 94158 USA
- Strelitz Endocrine and Metabolic Center and Neuroendocrine Unit, Eastern Virginia Medical School, P.O. Box 1980, Norfolk, VA 23501 USA
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute On Aging, National Institute of Health, 7201 Wisconsin Avenue, Gateway Building, Suite 2N300, Bethesda, MD 20814 USA
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Mojtaba M, Alinaghizadeh H, Rydwik E. Downton Fall Risk Index during hospitalisation is associated with fall-related injuries after discharge: a longitudinal observational study. J Physiother 2018; 64:172-177. [PMID: 29914804 DOI: 10.1016/j.jphys.2018.05.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 03/26/2018] [Accepted: 05/08/2018] [Indexed: 11/16/2022] Open
Abstract
QUESTIONS Among older people who are hospitalised, what is the predictive validity of the Downton Fall Risk Index (DFRI) in relation to fall-related injury after discharge? What is the predictive validity of the DFRI among males and females in this setting? DESIGN Prospective, longitudinal, observational study. PARTICIPANTS All hospital admissions during 2012 at three geriatric clinics in the Stockholm County Council were monitored. Patients aged>65years who did not die during the admission and who lived in the Stockholm County Council region were included. OUTCOME MEASURES The DFRI consists of five modules: previous falls, medication, sensory deficits, mental state, and gait. Three or more points indicate an increased fall risk. Data on DFRI, health status and medications were collected prior to discharge. Data regarding fall-related injuries were collected up to 6 months after discharge. Poisson multivariate regression analyses were conducted to evaluate the association between DFRI and fall-related injuries. RESULTS In total, 6650 patients were analysed. The cut-off≥3 points in the DFRI was significantly associated with fall-related injury when confounding variables were controlled for (IRR 1.94, 95% CI 1.60 to 2.38). Among individual modules, only previous falls (IRR 2.58, 95% CI 2.22 to 3.01) and unsafe gait (IRR 1.79, 95% CI 1.53 to 2.09) were associated with fall-related injuries. Stratified analyses showed a higher risk ratio for men compared to women regarding the DFRI, but the test for an interaction effect was not significant. CONCLUSION The risk of post-discharge fall-related injury is increased among older hospitalised people with an increased fall risk, according to the DFRI, especially those who had previous falls or unsafe gait. Although the DFRI tool is predictive, previous falls and gait are the measures that are most worthy of focus. [Mojtaba M, Alinaghizadeh H, Rydwik E (2018) Downton Fall Risk Index during hospitalisation is associated with fall-related injuries after discharge: a longitudinal observational study. Journal of Physiotherapy 64: 172-177].
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Affiliation(s)
| | - Hassan Alinaghizadeh
- Academic Primary Care Center, Stockholm County Council, Stockholm; Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala
| | - Elisabeth Rydwik
- FOU nu Research and Development Center for the Elderly, Stockholm County Council, Stockholm; Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Insitutet, Huddinge, Sweden
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Ambulatory blood-pressure monitoring, antihypertensive therapy and the risk of fall injuries in elderly hypertensive patients. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2018; 15:284-289. [PMID: 29915618 PMCID: PMC5997611 DOI: 10.11909/j.issn.1671-5411.2018.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Fall injuries are common among the elderly. The aim of this study was to investigate whether blood-pressure patterns, as measured by 24-h ambulatory blood pressure monitoring (ABPM), or intensification of antihypertensive therapy following the 24-h ABPM, may be associated with fall injuries in hypertensive elderly patients. Methods In a retrospective study, community-based elderly patients (age ≥ 70 years) who were referred to 24-h ABPM were evaluated for fall injuries within one-year post-ABPM. We compared the clinical characteristics, 24-h ABPM patterns and the intensification of hypertensive therapy following 24-h ABPM, between patients with and without a fall injury. Results Overall 1032 hypertensive elderly patients were evaluated. Fifty-five (5.3%) had a fall injury episode in the year following ABPM. Patients with a fall injury were significantly older, and with higher rates of previous falls. Lower 24-h diastolic blood-pressure (67.3 ± 7.6 vs. 70.7 ± 8.8 mmHg; P < 0.005) and increased pulse-pressure (74.7 ± 14.3 vs. 68.3 ± 13.7 mmHg; P < 0.005), were found in the patients with a fall injury, compared to those without a fall injury. After adjustment for age, gender, diabetes mellitus and previous falls, lower diastolic blood-pressure and increased pulse-pressure were independent predictors of fall injury. Intensification of antihypertensive treatment following the 24-h ABPM was not associated with an increased rate of fall injury. Conclusions Low diastolic blood-pressure and increased pulse-pressure in 24-h ABPM were associated with an increased risk of fall injury in elderly hypertensive patients. Intensification of antihypertensive treatment following 24-h ABPM was not associated with an increased risk of fall injury.
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Saftari LN, Kwon OS. Ageing vision and falls: a review. J Physiol Anthropol 2018; 37:11. [PMID: 29685171 PMCID: PMC5913798 DOI: 10.1186/s40101-018-0170-1] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 03/28/2018] [Indexed: 01/12/2023] Open
Abstract
Background Falls are the leading cause of accidental injury and death among older adults. One of three adults over the age of 65 years falls annually. As the size of elderly population increases, falls become a major concern for public health and there is a pressing need to understand the causes of falls thoroughly. Main body of the abstract While it is well documented that visual functions such as visual acuity, contrast sensitivity, and stereo acuity are correlated with fall risks, little attention has been paid to the relationship between falls and the ability of the visual system to perceive motion in the environment. The omission of visual motion perception in the literature is a critical gap because it is an essential function in maintaining balance. In the present article, we first review existing studies regarding visual risk factors for falls and the effect of ageing vision on falls. We then present a group of phenomena such as vection and sensory reweighting that provide information on how visual motion signals are used to maintain balance. Conclusion We suggest that the current list of visual risk factors for falls should be elaborated by taking into account the relationship between visual motion perception and balance control.
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Affiliation(s)
- Liana Nafisa Saftari
- Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, 44919, South Korea
| | - Oh-Sang Kwon
- Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, 44919, South Korea.
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Foster EJ, Barlas RS, Bettencourt-Silva JH, Clark AB, Metcalf AK, Bowles KM, Potter JF, Myint PK. Long-Term Factors Associated With Falls and Fractures Poststroke. Front Neurol 2018; 9:210. [PMID: 29666603 PMCID: PMC5891595 DOI: 10.3389/fneur.2018.00210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/16/2018] [Indexed: 12/21/2022] Open
Abstract
Background Risk factors for poststroke falls and fractures remain poorly understood. This study aimed to evaluate which factors increased risk of these events after stroke. Methods Data from 7,267 hospitalized stroke patients were acquired from the Norfolk and Norwich University Hospital Stroke Register from 2003–2015. The impacts of multiple patient level and stroke characteristics and comorbidities on post-discharge falls and fractures were assessed. Univariate and multivariable models were constructed, adjusting for multiple confounders, using binary logistic regression for short-term analysis (up to 1-year post-discharge) and Cox-proportional hazard models for longer term analysis (1–3, 3–5, and 0–10 years follow-up). Results The mean age (SD) was 76.3 ± 12.1 years at baseline. 1,138 (15.7%) participants had an incident fall; and 666 (9.2%) an incident fracture during the 10-year follow-up (total person years = 64,447.99 for falls and 67,726.70 for fractures). Half of the sample population were females (50.6%) and the majority had an ischemic stroke (89.8%). After adjusting for confounders: age, sex, previous history of falls, and atrial fibrillation were associated with an increased risk of both falls and fractures during follow-up. Furthermore, chronic kidney disease and hyperlipidemia were associated with an increased risk of falls, while previous stroke/transient ischemic attack increased fracture risk. Total anterior circulation stroke and a prestroke modified Rankin Scale score of 3–5 were associated with decreased risk of both events, with hypertension and cancer decreasing risk of falls only. Conclusion We identified demographic, stroke-related, and comorbid factors associated with poststroke falls and fracture incidence. Further studies are required to examine and establish the relationship between reversible factors and further explore the role of preventative measures to prevent poststroke falls and fractures.
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Affiliation(s)
- Emma J Foster
- Ageing Clinical and Experimental Research (ACER) Team, School of Medicine, Medical Sciences & Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Raphae S Barlas
- Ageing Clinical and Experimental Research (ACER) Team, School of Medicine, Medical Sciences & Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Joao H Bettencourt-Silva
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Allan B Clark
- Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Anthony K Metcalf
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Kristian M Bowles
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - John F Potter
- Norfolk and Norwich University Hospital, Norwich, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
| | - Phyo K Myint
- Ageing Clinical and Experimental Research (ACER) Team, School of Medicine, Medical Sciences & Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, United Kingdom
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Momtaz YA, Hamid TA, Haron SA, Bagat MF, Mohammadi F. Prevalence of hypotension and its association with cognitive function among older adults. Aging Ment Health 2018; 22:447-452. [PMID: 28060530 DOI: 10.1080/13607863.2016.1268093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE The negative effect of hypertension has overshadowed possible health problems associated with hypotension. The purposes of this study were to describe the prevalence of hypotension in older adults and to determine the association between hypotension and cognitive function, after adjusting for possible covariates. METHODOLOGY The data for the study consisting of 1067 community-dwelling older adults were obtained from a national survey entitled "Identifying Psychosocial and Identifying Economic Risk Factor of Cognitive Impairment among Elderly", conducted in Malaysia. The hypotension was considered as blood pressure <120/75 mm Hg, measuring by standard mercury manometer. Data analysis was performed using the SPSS Version 22.0. RESULTS The mean age of the respondents was 68.27 (SD = 5.93). Mean score of cognitive function as measured by MMSE was 22.70 (SD = 4.95). The prevalence of hypotension was 29.3%. The prevalence of cognitive impairment for hypotension group was 25.6%. Results of multiple linear regression analysis revealed that hypotension is negatively associated with cognitive function (Beta = -0.11, p<.01), after adjusting for age, gender, education, marital status, employment status, diabetes, heart disease, stroke and gastritis. CONCLUSION The study showing hypotension is significantly associated with decreased cognitive function in later life, implies more attention to low blood pressure in old age.
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Affiliation(s)
- Yadollah Abolfathi Momtaz
- a Iranian Research Center on Aging , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.,b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Tengku Aizan Hamid
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Sharifah Azizah Haron
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Mohamad Fazdillah Bagat
- b Malaysian Research Institute on Ageing (MyAgeing) , Universiti Putra Malaysia , Selangor , Malaysia
| | - Fatemeh Mohammadi
- c School of Nursing & Midwifery , Qazvin University of Medical Sciences , Qazvin , Iran
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Du Y, Wolf IK, Knopf H. Association of psychotropic drug use with falls among older adults in Germany. Results of the German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). PLoS One 2017; 12:e0182432. [PMID: 28792521 PMCID: PMC5549725 DOI: 10.1371/journal.pone.0182432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/18/2017] [Indexed: 12/15/2022] Open
Abstract
Purpose To investigate the association of psychotropic drug use with falls among older adults in Germany based on data from the National Health Interview and Examination Survey for Adults 2008–2011 (DEGS1). Methods DEGS1 collected data on drug use in the past 7 days and on falls occurred in the last 12 months. Study participants were older adults aged 65–79 years with complete data on drug use and falls (N = 1,833). Odds ratio (OR) and 95% confidence intervals (95% CI) were derived from logistic regression models adjusting for potential confounders including socio-demographic characteristics, health-related behaviors (alcohol drinking), body mass index and health conditions (frailty, vision impairment, disability, polypharmacy, blood pressure) as well as use of potential falls-risk-increasing drugs. SPSS complex sample methods were used for statistical analysis. Results Compared to people without falls, people with falls (n = 370) had a higher psychotropic drug use (33.1% vs. 20.7%, p < .001). After adjusting for potential confounders, use of psychotropic drugs overall was associated with a higher risk of falls (OR 1.64, 95% CI 1.14–2.37). This was particularly true for the use of synthetic psychotropic drugs (1.57, 1.08–2.28), antidepressants overall (2.88, 1.63–5.09) or synthetic antidepressants (2.66, 1.50–4.73), specifically, selective serotonin reuptake inhibitors (SSRIs) (6.22, 2.28–17.0). Similar results were found for recurrent falls. Conclusions Use of psychotropic drugs overall, especially synthetic antidepressants like SSRIs, is associated with higher risks of falls and recurrent falls among community dwelling older adults aged 65–79 years in Germany.
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Affiliation(s)
- Yong Du
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin Germany
- * E-mail:
| | - Ingrid-Katharina Wolf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin Germany
| | - Hildtraud Knopf
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin Germany
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Briggs R, Kenny RA, Kennelly SP. Does baseline hypotension predict incident depression in a cohort of community-dwelling older people? Data from The Irish Longitudinal Study on Ageing (TILDA). Age Ageing 2017; 46:648-653. [PMID: 28338875 DOI: 10.1093/ageing/afx033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Indexed: 01/16/2023] Open
Abstract
Background hypotension is now recognised as a risk factor for syncope, cardiovascular events and mortality, but it may also represent a risk factor for late life depression (LLD). The aim of this study was to clarify the longitudinal relationship between hypotension and incident LLD. Methods this is a longitudinal study involving community-dwelling participants aged ≥50 years, using data from The Irish Longitudinal Study on Ageing. The Centre for Epidemiological Studies Depression Scale (CES-D) was administered at baseline and at follow-up 2 years later. Blood pressure (BP) was measured at baseline. Participants with a CES-D score ≥16 at baseline and those taking antidepressants were excluded and considered to have a current diagnosis of depression. A score of ≥16 at follow-up was used to define incident depression. Results about 4,525 participants were included and 200 participants had diagnosis of incident LLD. The incident depression group had lower systolic BP at baseline than the non-depressed group (132.8 ± 1.43 mm Hg vs. 136.0 ± 0.30 mm HG, P = 0.025). Logistic regression showed those with systolic BP <130 mm HG had an unadjusted odds ratio of 1.31 (1.01-1.68) for incident depression. This persisted after adjustment for confounding factors. Conclusion systolic BP <130 mm Hg increased the likelihood of incident depression in a cohort of community-dwelling older adults. These findings are important because systolic hypotension may represent a potentially modifiable risk factor for LLD. They are also relevant in the context of BP treatment targets for older people.
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Affiliation(s)
- Robert Briggs
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
- Department of Medical Gerontology, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
- Department of Age-Related Health Care, Tallaght Hospital, Dublin 24, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
- Department of Medical Gerontology, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
| | - Sean P Kennelly
- Department of Age-Related Health Care, Tallaght Hospital, Dublin 24, Ireland
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Bromfield SG, Ngameni CA, Colantonio LD, Bowling CB, Shimbo D, Reynolds K, Safford MM, Banach M, Toth PP, Muntner P. Blood Pressure, Antihypertensive Polypharmacy, Frailty, and Risk for Serious Fall Injuries Among Older Treated Adults With Hypertension. Hypertension 2017; 70:259-266. [PMID: 28652459 DOI: 10.1161/hypertensionaha.116.09390] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/09/2017] [Accepted: 05/18/2017] [Indexed: 01/28/2023]
Abstract
Antihypertensive medication and low systolic blood pressure (BP) and diastolic BP have been associated with an increased falls risk in some studies. Many older adults have indicators of frailty, which may increase their risk for falls. We contrasted the association of systolic BP, diastolic BP, number of antihypertensive medication classes taken, and indicators of frailty with risk for serious fall injuries among 5236 REGARDS study (Reasons for Geographic and Racial Difference in Stroke) participants ≥65 years taking antihypertensive medication at baseline with Medicare fee-for-service coverage. Systolic BP and diastolic BP were measured, and antihypertensive medication classes being taken assessed through a pill bottle review during a study visit. Indicators of frailty included low body mass index, cognitive impairment, depressive symptoms, exhaustion, impaired mobility, and history of falls. Serious fall injuries were defined as fall-related fractures, brain injuries, or joint dislocations using Medicare claims through December 31, 2014. Over a median of 6.4 years, 802 (15.3%) participants had a serious fall injury. The multivariable-adjusted hazard ratio for a serious fall injury among participants with 1, 2, or ≥3 indicators of frailty versus no frailty indicators was 1.18 (95% confidence interval, 0.99-1.40), 1.49 (95% confidence interval, 1.19-1.87), and 2.04 (95% confidence interval, 1.56-2.67), respectively. Systolic BP, diastolic BP, and number of antihypertensive medication classes being taken at baseline were not associated with risk for serious fall injuries after multivariable adjustment. In conclusion, indicators of frailty, but not BP or number of antihypertensive medication classes, were associated with increased risk for serious fall injuries among older adults taking antihypertensive medication.
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Affiliation(s)
- Samantha G Bromfield
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Cedric-Anthony Ngameni
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Lisandro D Colantonio
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - C Barrett Bowling
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Daichi Shimbo
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Kristi Reynolds
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Monika M Safford
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Maciej Banach
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Peter P Toth
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.)
| | - Paul Muntner
- From the Department of Epidemiology, Emory University, Atlanta, GA (S.G.B.); Department of Epidemiology, University of Alabama at Birmingham, AL (L.D.C., P.M.); Cigna HealthSpring, Birmingham, AL (C.-A.N.); Department of Veterans Affairs, Geriatric Research, Education and Clinical Center, Durham, NC (C.B.B.); Department of Medicine, Columbia University Medical Center, New York, NY (D.S.); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (K.R.); Department of Medicine, Weill Cornell Medicine, New York, NY (M.M.S.); Department of Hypertension, Medical University of Lodz, Poland (M.B.); Community General Hospital Medical Center, Sterling, IL (P.P.T.); and Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD (P.P.T.).
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Aoki S, Hosomi N, Nezu T, Teshima T, Sugii H, Nagahama S, Kurose Y, Maruyama H, Matsumoto M. Blood pressure control with cilnidipine treatment in Japanese post-stroke hypertensive patients: The CA-ATTEND study. Clin Exp Hypertens 2017; 39:225-234. [PMID: 28448181 DOI: 10.1080/10641963.2016.1235183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Blood pressure control is important in post-stroke hypertensive patients and antihypertensive treatment is recommended for such patients. Ca-channel blockers are recommended as the medications of choice for the treatment of post-stroke patients. Here, we report the results of a large-scale prospective post-marketing surveillance study of post-stroke hypertensive patients (n = 2667, male 60.4%, 69.0 ± 10.9 years) treated with cilnidipine, with regard to blood pressure control and adverse reactions. Cilnidipine treatment caused a decrease in both clinic and home blood pressures 2 months after the beginning of treatment, and the decreased blood pressure was maintained until the end of 12 months' observation. The proportion of patients in whom clinic blood pressure was well controlled (<140/90 mmHg) increased from 21.5% to 65.3% in cilnidipine treatment, with no differences in effectiveness among the various clinical subtypes of stroke. In total, 346 adverse events occurred, with an overall incidence of 8.9% (238 of 2667 patients). In the elderly group, specifically, a fall and a hip fracture each occurred in 1 (0.1%) patient. These results indicate that cilnidipine was effective in treating uncontrolled blood pressure and was well tolerated in Japanese post-stroke hypertensive patients in a real-world clinical setting.
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Affiliation(s)
- Shiro Aoki
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Naohisa Hosomi
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Tomohisa Nezu
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Tsukasa Teshima
- b Post-Marketing Surveillance , Mochida Pharmaceutical Co., Ltd. , Tokyo , Japan
| | - Hitoshi Sugii
- b Post-Marketing Surveillance , Mochida Pharmaceutical Co., Ltd. , Tokyo , Japan
| | - Shinobu Nagahama
- c Post-Marketing Medical Research Department , EA Pharma Co., Ltd. , Tokyo , Japan
| | - Yoshiki Kurose
- c Post-Marketing Medical Research Department , EA Pharma Co., Ltd. , Tokyo , Japan
| | - Hirofumi Maruyama
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
| | - Masayasu Matsumoto
- a Department of Clinical Neuroscience and Therapeutics , Hiroshima University Graduate School of Biomedical and Health Sciences , Hiroshima , Japan
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Abstract
BACKGROUND Information relating the severity of cognitive decline to the fall risk in institutionalized older adults is still scarce. This study aims to identify potential fall risk factors (medications, behavior, motor function, and neuropsychological disturbances) depending on the severity of cognitive impairment in nursing home residents. METHODS A total of 1,167 nursing home residents (mean age 81.44 ± 8.26 years; 66.4% women) participated in the study. According to the MEC, (the Spanish version of the Mini-Mental State Examination) three levels of cognitive impairment were established: mild (20-24) "MCI", moderate (14-19) "MOCI", and severe (≤14) "SCI". Scores above 24 points indicated the absence cognitive impairment (NCI). Information regarding fall history and fall risk during the previous year was collected using standardized questionnaires and tests. RESULTS Sixty falls (34%) were registered among NCI participants and 417 (43%) among people with cognitive impairment (MCI: 35%; MOCI: 40%; SCI: 50%). A different fall risk model was observed for MCI, MOCI, SCI, and NCI patients. The results imply that the higher the level of cognitive impairment, the greater the number of falls (F1,481 = 113.852; Sig = 0.015), although the level of significance was not maintained when MOCI and SCI participants were compared. Depression, neuropsychiatric disturbances, autonomy constraints in daily life activity performance, and low functional mobility were factors closely associated with fall risk. CONCLUSION This study provides evidence indicating that fall risk factors do not hold a direct correlation with the level of cognitive impairment among elderly nursing home care residents.
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Abstract
The importance of high blood pressure (BP) and the effect of BP lowering in older adults remain controversial due to the mixed evidence in this population. Frailty status may resolve the apparently conflicting findings and identify subpopulations who share common risk. Emerging evidence demonstrates that low BP is associated with poor outcomes in older frail adults or those with poor functional status. In contrast, in non-frail older adults, low BP appears beneficial. Frail older adults may be at increased risk of hypotension, serious fall injuries, and polypharmacy. Additionally, peripheral BP may not be the best prognostic measure in this population. The majority of clinical practice guidelines give little recommendation for frail older adults, which is likely due to their systematic underrepresentation in randomized controlled trials. Future studies need to consider modifications to safely include frail older adults, and guidelines should consider inclusion of evidence beyond randomized controlled trials.
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Zia A, Kamaruzzaman SB, Tan MP. Blood pressure lowering therapy in older people: Does it really cause postural hypotension or falls? Postgrad Med 2015; 127:186-93. [DOI: 10.1080/00325481.2015.996505] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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50
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Stevens JA. The STEADI Tool Kit: A Fall Prevention Resource for Health Care Providers. THE IHS PRIMARY CARE PROVIDER 2013; 39:162-166. [PMID: 26766893 PMCID: PMC4707964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Judy A Stevens
- Epidemiologist, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
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